Brief Answer: Visit your nearest ER at the earliest. Detailed Answer: Hi XXXXX ! Good morning. I am Dr Shareef answering your query. To be able to answer your query properly, the following information would be more helpful: 1) Is this blood pressure reading is first of such instance or you had such blood pressure reading earlier as well ? 2) Did you get your blood sugar and other basic routine blood investigations done recently ? 3) What is the total duration of such symptoms from the past ? 4) Does the pain radiate to any other part of the body ? 5) Can you please brief me about your dietary and bowel habits ? 6) Are you on any kind of medications ? For the present, if I were your doctor, I would either bring your blood pressure down following which would go for investigations like an ECG,Echo cardiogram, cardiac enzymes estimation in the blood, and all other routine blood tests like a CBC, Blood Sugar, renal function tests, serum lipid profile,and a liver function test. Depending on these, I might consider for a CT angio to exclude a cardiac cause with more certainty. For an immediate relief, I would give you a tablet of sublingual sorbitrate which will take care both of any cardiac or esophageal cause for your discomfort and advise you to report at the ER at the earliest. Rest of the discussions could be done after you are cleared from your ER and after getting information sought from you as above. I hope this information would help you in discussing with your family physician/treating doctor in further management of your problem. Please do not hesitate to ask in case of any further doubts. Thanks for choosing health care magic to clear doubts on your health problems. Wishing you an early recovery. Dr Shareef.

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Brief Answer: I would still go for a repeat cardiac review. Detailed Answer: Hi XXXXX ! Nice to have such a fast response from you. From the history of getting relief on holding your breath goes more in favour of an esophageal problem like a gastro esophageal reflux for which might have been aggravated by your hypothyroid state. I hope your TSH level is within normal limits at present or else your levothyroxine dose might need an adjustment. Presuming it to be a esophageal problem, I would advise you to raise the head end of your bed with one or two blocks,so that the regurgitation symptoms get reduced. You have to continue taking the proton pump inhibitor, with a possible addition of a prokinetic drug after consulting your family physician.Also avoid remaining empty stomach which might cause increase in your gastric problems due to hyper acidity. Try frequent small diet which should be light. However, with your fluctuating blood pressure level, I would still go for a repeat complete cardiac check up by your cardiologist to be on a safer side and you have to discuss on this with your family physician. I hope this will help you in further management of your problem. In case of any further clarification, please feel free to ask. Thanks. Dr Shareef.

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