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How are chest tightness and pain treated ?

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Internal Medicine Specialist
Practicing since : 1998
Answered : 1579 Questions
Hi, I am wondering what to do. I have a family history of heart disease so this worries me. I have chest tightness and had a sharp pain the other day, under my heart area. i have continued this chest heaviness for about a week but I have noticed exhaustion before that, for 2 weeks now, and I feel like I can fall asleep on a dime. But then, when I go to sleep, I can't fall asleep, even after taking my meds at night (Trazodone, 200mgs, Xanax, 1 mg, Lexapro, 20 mgs). I am constantly tired and want to sleep. My meds don't help me sleep (I even took it at 8pm last night and woke up at 11:45, STILL exhausted). I have sleep apnea and have made sure my mask doesn't leak. I can't understand the overall exhaustion and aches and pains in my body. What could be wrong??? Thank you for a quick response.
Posted Mon, 30 Apr 2012 in Lung and Chest disorders
Answered by Dr. Jasvinder Singh 3 hours later

Thanks for posting your query. I have noted your details and the following are the possiblities:

1. Any chest pain is considered cardiac in origin unless proved otherwise. From the symptoms that you have mentioned, I would suggest you to get a cardiac check up done first, to rule out any cardiac cause. You need electrocardiogram, blood tests (cardiac markers), cardiac stress testing and stress ECHO. You may visit your primary care provider and get these test done.

2. Secondly, it can be due to gastroesophageal reflux disease (GERD) that can cause such chest tightness and mimics a heart condition. GERD can also cause insomnia by waking up the person at night due to acid reflux and he finds it difficult to sleep.
Avoid alcohol or drinks with caffeine in them, chocolate or spicy or greasy foods and instead take cold foods preferably liquids like milk and yoghurt. It also might help to avoid eating or drinking for two hours before you lie down. You may also need antacids regularly for a few days. Proton pump inhibitor (Prilosec) one tablet a day may be used in addition for a few days for controlling the stomach acid.

3. Difficulty in sleep can be due to the worsening of sleep apnea which you already have. Or it might be due to rebound insomnia that can occur due to benzodiazepine drugs over use. GERD. anxiety and depression are also known to affect sleep.
A sleep study needs to be done and if needed medicines changed (Xanax, Trazodone , Lexapro) or dose decreased.

Hope this answers your query.

If you have additional questions or follow up queries then please do not hesitate in writing to us. Also please do share with us the reports of the above mentioned investigations. I will be happy to answer your queries.

Wishing you good health.


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