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Suggest Treatment For Pain In Chest Area
Question: Pain in chest area frm last week again last night ecg and enzyme test done normal,tmt and echo normal two month back several ecg during the pain. Heart prb??
I m worried abt heart attack and blockage pain center left right can happen anywhaere
I m worried abt heart attack and blockage pain center left right can happen anywhaere
Brief Answer:
Heart problem unlikely, Consider gastric reflux as a possibility
Detailed Answer:
Hello ,
I am Dr. Mody and I would be addressing your concern.
Considering your age and absence of any risk factor like hypertension, diabetes , and nomral scarring which included an echocardiography and TMT, virtually we can rule out underlying critical cardiac disease and no furthur investigation is needed for the same .
However if you smoke , are obese and have a bad lifestyle with a strong family history, and to be 100 % sure , you can go out for a CT coronary angiogram, it's a CT scan through which one can see the anatomy of the heart arteries, if it's nomral in 99.6 % cases there is no problem and you can safely rule out heart as the cause of the pain.
Stomach or muscular may be two possibility which is still a more common possibility in your case .
Hoping I could help .
Let me know if any clarification needed and I would be happy to help.
Regards Dr Priyank Mody
Heart problem unlikely, Consider gastric reflux as a possibility
Detailed Answer:
Hello ,
I am Dr. Mody and I would be addressing your concern.
Considering your age and absence of any risk factor like hypertension, diabetes , and nomral scarring which included an echocardiography and TMT, virtually we can rule out underlying critical cardiac disease and no furthur investigation is needed for the same .
However if you smoke , are obese and have a bad lifestyle with a strong family history, and to be 100 % sure , you can go out for a CT coronary angiogram, it's a CT scan through which one can see the anatomy of the heart arteries, if it's nomral in 99.6 % cases there is no problem and you can safely rule out heart as the cause of the pain.
Stomach or muscular may be two possibility which is still a more common possibility in your case .
Hoping I could help .
Let me know if any clarification needed and I would be happy to help.
Regards Dr Priyank Mody
Above answer was peer-reviewed by :
Dr. Raju A.T
Thank u Sir...
but sometime its radiate to left hand and neck
might be due to cervical disc bulge problem i m not sure but sweating never feel,
Generally the pain start frm morning and till evening its more till night,
and even while using stairs upto 2 floors my lungs pump and heart running fast
Stress TMT & ECHO done few months back and normal. two time enzymes & 13 times ecg done at different location
Yes Sir i hv very bad gas and indigestion problem frm so many years ( i quit smoking & alchoal almost 5 yr now) and i m daily taken Sompraz-L (Esmaprazole + Levosulpride) from few months. sir as advice by you i will try to discuss with Psychiatrist soon . but i m in trap that i have some heart problem and i want to come out with. i will go for CT Angio ..
Sir even not heart family history
but sometime its radiate to left hand and neck
might be due to cervical disc bulge problem i m not sure but sweating never feel,
Generally the pain start frm morning and till evening its more till night,
and even while using stairs upto 2 floors my lungs pump and heart running fast
Stress TMT & ECHO done few months back and normal. two time enzymes & 13 times ecg done at different location
Yes Sir i hv very bad gas and indigestion problem frm so many years ( i quit smoking & alchoal almost 5 yr now) and i m daily taken Sompraz-L (Esmaprazole + Levosulpride) from few months. sir as advice by you i will try to discuss with Psychiatrist soon . but i m in trap that i have some heart problem and i want to come out with. i will go for CT Angio ..
Sir even not heart family history
Brief Answer:
CT angiography is suggested for its negative predictive value
Detailed Answer:
Hello Sir , As I had mentioned that you don't have the risk factors and the chances of you having any heart problem is negligible.
A CT coronary angiogram is suggested in view of breaking this cycle of anxiety, as it's a test which is nearly 100 % right when it's negative . However there is no urgency.
Lastly levosulpuride for long term has side effects , Do consult your doctor for the same .
A safer alternative will be Tab sompraz d, which contains domperidome instead of levosulpuride, which doesn't cross to the brain and has minimal side effects as compared to levosulpuride in long run .
Wishing you good health.
Regards Dr Priyank Mody
CT angiography is suggested for its negative predictive value
Detailed Answer:
Hello Sir , As I had mentioned that you don't have the risk factors and the chances of you having any heart problem is negligible.
A CT coronary angiogram is suggested in view of breaking this cycle of anxiety, as it's a test which is nearly 100 % right when it's negative . However there is no urgency.
Lastly levosulpuride for long term has side effects , Do consult your doctor for the same .
A safer alternative will be Tab sompraz d, which contains domperidome instead of levosulpuride, which doesn't cross to the brain and has minimal side effects as compared to levosulpuride in long run .
Wishing you good health.
Regards Dr Priyank Mody
Above answer was peer-reviewed by :
Dr. Sonia Raina
Sir today CT coronary angio with XXXXXXX done in fortis escort in emergency dept. and Dr internally verify and said normal report no issue hardcopy and final report yet to come ... But Dr confirm its a normal... Sir so now i hv to be 100% sure that i hv no heart proble any blocakge etc??? Becuase from today morning i hv very pain full chest pain while driving the car .. Sir your final verdict pls
Brief Answer:
Yes you can rule out heart as the cause . Regards
Detailed Answer:
Hello Sir , yes by all means one can safely rule even a minor cardiac disease once a stress test and a CT coronary angiogram is normal .
It's not heart for sure. Also in stomach rule out GERD - reflux gastritis whereby stomach acid is refluxed back into the food pipe causing the characteristic symptoms you describe.
If symptoms persists a Upper GI scopy would help rule out the same .
Wishing you an healthy life .
Regards Dr Priyank Mody
Yes you can rule out heart as the cause . Regards
Detailed Answer:
Hello Sir , yes by all means one can safely rule even a minor cardiac disease once a stress test and a CT coronary angiogram is normal .
It's not heart for sure. Also in stomach rule out GERD - reflux gastritis whereby stomach acid is refluxed back into the food pipe causing the characteristic symptoms you describe.
If symptoms persists a Upper GI scopy would help rule out the same .
Wishing you an healthy life .
Regards Dr Priyank Mody
Above answer was peer-reviewed by :
Dr. Sonia Raina
Thanks you Sir for your valuable feedback & giving me confidence back ... here i attach my report pls have a look and final verdict ...:-) this is my last follow up question .. Thanks
Brief Answer:
There is no blockage except evidence of myocardial bridging
Detailed Answer:
Hello , I went through the report attached.
As we had thought there is no blockage in the heart arteries and ypu can be 100 % sure about the same .
So reflux gastritis remains the most probable reason for your symptoms.
However just to note that you have something called myocardial bridging, which may sometimes cause heartache which is characteristic like angina ( pain arising from the heart ) ,the mechanism for the same and need for furthur evaluation ( mostly a stress thallium) would be difficult to explain on this platform .Do discuss the same with your cardiologist on the next visit or you may drop a call through HCM, If all other reasons for your symptoms have been ruled out than only this avenue should be explored as it's not common for bridging to cause symptoms. And you can be sure that it is never going to cause heart attack , only it cause cause angina like symptom.
Hoping I could help .
Sorry for bringing this new thing , however as your report was reviewed atlast it was , it was my duty to interpret it for you .
Regards Dr Priyank Mody
There is no blockage except evidence of myocardial bridging
Detailed Answer:
Hello , I went through the report attached.
As we had thought there is no blockage in the heart arteries and ypu can be 100 % sure about the same .
So reflux gastritis remains the most probable reason for your symptoms.
However just to note that you have something called myocardial bridging, which may sometimes cause heartache which is characteristic like angina ( pain arising from the heart ) ,the mechanism for the same and need for furthur evaluation ( mostly a stress thallium) would be difficult to explain on this platform .Do discuss the same with your cardiologist on the next visit or you may drop a call through HCM, If all other reasons for your symptoms have been ruled out than only this avenue should be explored as it's not common for bridging to cause symptoms. And you can be sure that it is never going to cause heart attack , only it cause cause angina like symptom.
Hoping I could help .
Sorry for bringing this new thing , however as your report was reviewed atlast it was , it was my duty to interpret it for you .
Regards Dr Priyank Mody
Above answer was peer-reviewed by :
Dr. Sonia Raina
Thank u Sir for guiding me about this ... Now a little confusion abt this . Is this problem is life threatning or cause of sudden heart attack .. I discussd with Cardiologist at XXXXXXX he said no problem its normal no need to worry ... What should i do sir more confused and worried now .. And what is the treatment of this ... I m very worried abt heart attack and other problem due to this i hope you can understand my situation as a patient .. Pls guide further on this issuehow can i contact on phone if its possible i m in XXXXXXX
Brief Answer:
Nothing to worry, you will never have an heart attack because of it
Detailed Answer:
Hello ,
As I has said , by no means is this ever going to cause heart attack or any life threatening condition . So you can be rest assured about the same .
It's a very benign cause which is very common in general population and is since birth and many doesn't even know about the same . We also came to know as went for a CT coronary angiogram. Considering you have done a stress test , which is negative ( it means that your heart is supplied with enough blood even during exertion ) , we can judge that myocardial bridging is of mild variety.
Lastly If have ro simply explain the concept of myocardialbridging, it's like in nomral population tge coronary arteries are outside the heart muscle , sometimes a small segment of arteries may be withen the heart muscle , so each time the heart muscle contracts it may constrict the arteries decreasing blood supply transiently which would come to normal in a fraction of second .
So nothing to worry about heart as of now .
Do take care of the stomach part and you should be all right .
I am based in XXXXXXX the number would be 0000 if any urgency .
Wishing you good health.
Regards Dr Priyank Mody
Nothing to worry, you will never have an heart attack because of it
Detailed Answer:
Hello ,
As I has said , by no means is this ever going to cause heart attack or any life threatening condition . So you can be rest assured about the same .
It's a very benign cause which is very common in general population and is since birth and many doesn't even know about the same . We also came to know as went for a CT coronary angiogram. Considering you have done a stress test , which is negative ( it means that your heart is supplied with enough blood even during exertion ) , we can judge that myocardial bridging is of mild variety.
Lastly If have ro simply explain the concept of myocardialbridging, it's like in nomral population tge coronary arteries are outside the heart muscle , sometimes a small segment of arteries may be withen the heart muscle , so each time the heart muscle contracts it may constrict the arteries decreasing blood supply transiently which would come to normal in a fraction of second .
So nothing to worry about heart as of now .
Do take care of the stomach part and you should be all right .
I am based in XXXXXXX the number would be 0000 if any urgency .
Wishing you good health.
Regards Dr Priyank Mody
Above answer was peer-reviewed by :
Dr. Yogesh D
Thank u so much sir for clear my all doubts .. One last question when i walking after dinner the chest pain increase while walking in center upper area .. What could be the cause As such no breathing issue as well and heart beat normal after 5 min rest but chest pain at upper center area not normal pls give me u r valuable inputs
Brief Answer:
Rule out GERD ( Gastro esophageal reflux disease ) as the cause
Detailed Answer:
Hello ,
As we had discussed pain particularly after dinner may be because of Reflux gastritis .
Smaller and more frequent meals , less carbohydrates and more fiber in the meal would help you get rid of the pain.
Lastly a Upper GIT scopy to know the extent of stomach burn and at the same time a sample for H pylori after an review with your gastroenterology if the symptoms persists should be the way forward.
As I said you have ruled out cardiac cause and you need not worry about the same .
Regards Dr Priyank Mody,
Rule out GERD ( Gastro esophageal reflux disease ) as the cause
Detailed Answer:
Hello ,
As we had discussed pain particularly after dinner may be because of Reflux gastritis .
Smaller and more frequent meals , less carbohydrates and more fiber in the meal would help you get rid of the pain.
Lastly a Upper GIT scopy to know the extent of stomach burn and at the same time a sample for H pylori after an review with your gastroenterology if the symptoms persists should be the way forward.
As I said you have ruled out cardiac cause and you need not worry about the same .
Regards Dr Priyank Mody,
Above answer was peer-reviewed by :
Dr. Yogesh D
Hi sir thanks ... GERD is rule out my physician Dr who is my friend he said gastric problem hai but not GERD so no need dor endroscopy test .. Sir my Cardio Dr prescribe me few medicine "Deplatt a 75" and "monotrate 10" and Dilzem 30 for 15 days and sos sorbitrade he said if no improvment then Gold standard Angio will be done and stress theelium test .. Now its again a cycle for me to think again sir i stick to u r words and suggestion its really help me to almost get out frm fear of heart attack and other problems ... Pls now i need u r advice n suggestion actaully Cardio told if pain is not stopped in 3 months then there is chance of put stunt uffff its really fear for me sir pls pls guide
Brief Answer:
I suggest you take second opinion of a XXXXXXX cardiologist
Detailed Answer:
Hello sir ,
If GERD is ruled out , than I won't discuss it furthur.
Now again coming to your heart .
If CT angiography is nomral than the need for conventional angiography doesn't arise and that's what standard of care throughout the world is .
As I said the symptoms may be because of myocardial bridge . For understanding blockages narrow the arteries from inside while this bridge compresses the artery from outside , but ultimately it's mild in majority of cases not causing any decrease in the blood supply.
The best way to know is to do a stress thallium , where your heart will be subjected to stress like TMT and the blood supply to the heart is checked by perfusion . If nomral the bridge is insignificant and should not be treated .
Deplatt A is a combination of 2 blood thinners and in absence of the block should not be taken in my opinion . Monotrate and dilzem role in myocardial bridge is not substantiated with any study .
As I have said it's something rare so discussion on this forum is not possible. But I strongly suggest that you take opinion of another XXXXXXX cardiologist before starting all medications . I am sorry for the trouble but without examination I may miss upon something , which would be not right.
So a second opinion with a XXXXXXX cardiologist is warranted and trust me there is nothing serious and for sure there is no requirement of stent particularly fro myocardial Bridge .
Hoping I could help .
Regards Dr Priyank Mody , XXXXXXX
I suggest you take second opinion of a XXXXXXX cardiologist
Detailed Answer:
Hello sir ,
If GERD is ruled out , than I won't discuss it furthur.
Now again coming to your heart .
If CT angiography is nomral than the need for conventional angiography doesn't arise and that's what standard of care throughout the world is .
As I said the symptoms may be because of myocardial bridge . For understanding blockages narrow the arteries from inside while this bridge compresses the artery from outside , but ultimately it's mild in majority of cases not causing any decrease in the blood supply.
The best way to know is to do a stress thallium , where your heart will be subjected to stress like TMT and the blood supply to the heart is checked by perfusion . If nomral the bridge is insignificant and should not be treated .
Deplatt A is a combination of 2 blood thinners and in absence of the block should not be taken in my opinion . Monotrate and dilzem role in myocardial bridge is not substantiated with any study .
As I have said it's something rare so discussion on this forum is not possible. But I strongly suggest that you take opinion of another XXXXXXX cardiologist before starting all medications . I am sorry for the trouble but without examination I may miss upon something , which would be not right.
So a second opinion with a XXXXXXX cardiologist is warranted and trust me there is nothing serious and for sure there is no requirement of stent particularly fro myocardial Bridge .
Hoping I could help .
Regards Dr Priyank Mody , XXXXXXX
Above answer was peer-reviewed by :
Dr. Sonia Raina
Thanks you so much sir for u r valueable inputs on my health and condition.. I will consult with another Sr. Cardio for sure .. Before that can i consult you on phone for 5 min .. Actually i want to rule out heart attack tension which is come back again in my mind i know u clear this point that ... One thing more i consult with at Safdaradjang hospital with asst professor cardiologist .. She also prescribe medicine for 3 months which she prescribe ...i attach her prescription for your consideration sir if u allow can i call you on u r given number it will really help me lots pls
Brief Answer:
Heart is still not the 1st differntial cause for your symptoms
Detailed Answer:
Hello ,
As discussed on a telephone.
1) No the medication by both doctors is not same
2) Myocardial bridging is not going to cause heart attack
3) Even the doctor in the prescription you have forwarded, has pit cervical spondylitis as the provisional diagnosis
4) Of heart is your concern, thallium scan should be a way forward.
Regards Dr Priyank Mody
Heart is still not the 1st differntial cause for your symptoms
Detailed Answer:
Hello ,
As discussed on a telephone.
1) No the medication by both doctors is not same
2) Myocardial bridging is not going to cause heart attack
3) Even the doctor in the prescription you have forwarded, has pit cervical spondylitis as the provisional diagnosis
4) Of heart is your concern, thallium scan should be a way forward.
Regards Dr Priyank Mody
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
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