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Suggest Treatment For Recurring Chest Pain

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Posted on Mon, 30 Mar 2015
Question: I have had chest pain for almost five years now. It started suddenly one night, not extremely painful but enough to where I was worried. I went to the ER and after having multiple EKG's, some blood work, a stress test (non-nuclear) and an echocardiogram I was sent home and told it was not heart related and to follow-up with my family doctor as well as the cardiologist who saw me in the ER. I followed up with the cardiologist and he simply assured me there was nothing wrong with my heart after taking another EKG at his office. I then saw my family doctor multiple times over the next several months complaining of the same issue (chest pain) and was eventually referred to a gastroenterologist. After one endoscopy I was told my stomach was not emptying properly. I then had a nuclear emptying study done and also a gallbladder test. The gallbladder test came out fine as well as the emptying study. I was then sent for another endoscopy. This time the endoscopy went fine but I was told there was a lot of acid erosion in my esophagus. Several samples were taken and sent out from the endoscopy but all came back OK. I was then placed on Dexilant (proton pump inhibitor) and told to take it once a day. After seeing no significant improvement I sought the care of another cardiologist, at my expense who took an initial EKG upon my first visit and said he saw a slight variation in my heart rhythm but after a second EKG all appeared normal. He also decided to do a stress test but this time with nuclear contrast due to my symptoms. The stress test revealed a possible blockage in one of my arteries. I was then sent for a 64 slice CT scan but instead opted for a cardiac catheterization to ensure nothing was wrong with my heart. After the test I was told everything looked fine. I had a very small percent of blockage which was normal for my age and also one slightly leaky heart valve but neither were issues. I was then told to relax and possibly see a psychiatrist for the continued pain as it was believed to possibly be from high anxiety (panic attacks). I then lived with the pain for a while and decided to change my family doctor to a concierge doctor for more personalized care. This doctor has done and is doing everything in his power to figure out what is causing the pain and has assured me it is not my heart as well. He reviewed the records from every doctor I have ever visited to compile my medical history. He has sent me for several tests related to GERD as well as performed an additional echocardiogram and EKG to safely alleviate my fears. At this point he is going to send me to another specialist that he knows well to perform an additional endoscopy and a test to see if my symptoms are being caused by nerves triggered by my GERD problems. My current concern is since over the weekend I have had severe chest pain at times, both with activity and at rest that leads from my chest to my back, left shoulder and arm and also causes me to occasionally cold sweat, feel short of breath and/or lightheaded. I will admit I have a very high anxiety level so I believe some of the symptoms to be related to that but most importantly not the chest pain. I have consulted with my doctor and he still feels it to be stomach related and nothing to do with my heart since it is not always caused by activity and sometimes still occurs while at rest. It almost feels positional sometimes. I am very worried and do not know what to do. I am 25 years old, 6'1", 275 lbs and generally have normal BP. I would also like to add that I was diagnosed with a severe sinus infection last week and still feel somewhat congested even though I have been on antibiotics and Mucinex-D. I now take Dexilant (proton pump inhibitor) regularly as well as sucrulfate, both for my GERD issues.
doctor
Answered by Dr. Ilir Sharka (6 hours later)
Brief Answer:
Seems that your chest pain is becoming a rebus.

Detailed Answer:
Hello! Thank you for asking on HCM! Regarding your concern I would like to explain that not rarely chest pain becomes a rebus to resolve.

Firstly, I would like to explain that your chest pain characteristics besides location and irradiation, have almost atypical nature to be ischemic heart problem (positional modulation, time of trigger, etc). Sure that doctors have judged right to investigate in several directions. I would like to emphasise at least three points:

(1) What is the implication of that innocent - appearing coronary stenosis? Could you send me please the coronarography report? Sometimes small lesions result important when functional testing is performed (fractional flow reserve measurement).

(2) What are the implications of digestive tract involvements? Is it GERD really evident? Does PPI therapy really alleviate your complains? Follow up endoscopies may be needed.

(3) Judging you pain characteristics, your weight, etc I think we have to exclude backbone degenerative findings sometime responsible for that kind of complain. X ray study comprising CTscan study may be needed.

(4) At the end, when nothing concludes a whole chest or chest - abdomen imagine studies should be performed (aorta, chest wall structures, etc).

Hope to have been helpful to you! Feel free to ask me whenever you need! Greetings from Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.

Above answer was peer-reviewed by : Dr. Shanthi.E
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Answered by
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Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 9536 Questions

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Suggest Treatment For Recurring Chest Pain

Brief Answer: Seems that your chest pain is becoming a rebus. Detailed Answer: Hello! Thank you for asking on HCM! Regarding your concern I would like to explain that not rarely chest pain becomes a rebus to resolve. Firstly, I would like to explain that your chest pain characteristics besides location and irradiation, have almost atypical nature to be ischemic heart problem (positional modulation, time of trigger, etc). Sure that doctors have judged right to investigate in several directions. I would like to emphasise at least three points: (1) What is the implication of that innocent - appearing coronary stenosis? Could you send me please the coronarography report? Sometimes small lesions result important when functional testing is performed (fractional flow reserve measurement). (2) What are the implications of digestive tract involvements? Is it GERD really evident? Does PPI therapy really alleviate your complains? Follow up endoscopies may be needed. (3) Judging you pain characteristics, your weight, etc I think we have to exclude backbone degenerative findings sometime responsible for that kind of complain. X ray study comprising CTscan study may be needed. (4) At the end, when nothing concludes a whole chest or chest - abdomen imagine studies should be performed (aorta, chest wall structures, etc). Hope to have been helpful to you! Feel free to ask me whenever you need! Greetings from Dr. Iliri