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Hot flushes, dizziness,rapid heartbeat, chest pain, GERD with barrett's esophagus, endoscopy and colonoscopy normal. Hypoglycemia or stress ?

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Orthopaedic Surgeon
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I am a 40 year old male, 5'8", 165 lbs. For a long time, I periodically (& seemingly randomly) feel like I am getting flushed/hot, dizzy, rapid heartbeat, and shallow breathing, sometimes (but not always) with chest pain. Sometimes I feel like I'm going to pass out, but I don't recall it having gone that far, although close to it. Sometimes the symptoms go away with eating a bunch of candy or something sugary, sometimes not. I have GERD with non-dysplastic Barrett's esophagus and have had endoscopies and colonoscopies. The endoscopies show only the Barrett's and the colonoscopies are very clean - no polyps or anything. My last general physical (about 2 years ago) was negative for diabetes. I have had high blood pressure in the past, but that seems to have gone away. EKG's about 2 years ago showed no signs of heart attack or stroke. The symptoms are more frequent now - pretty much every day for the past few weeks. Could it be hypoglycemia? Stress-related? I am worried that it could be something serious. Please help! Thanks in advance.
Posted Tue, 8 May 2012 in Hypertension and Heart Disease
Answered by Dr. Aashish Raghu 31 minutes later

Thanks for the query.

What medication are you taking at present?
How long does the chest pain last for when it occurs?
Does the chest pain radiate to the left arm or neck and chin?
Do you smoke, any family history of heart disease?

Your symptoms seem to fit a description of possible cardiovascular disturbance. You are suffering from hypertension which can put you at risk for heart conditions like angina pectoris and heart attacks as well. A complete heart evaluation that include cholesterol profile, kidney function tests, and most importantly a repeat Electrocardiogram (EKG). Other tests like treadmill test and Echocardiogram may be done as advised. You may get these test under the guidance of a cardiologist.

It is also possible that you may have hypoglycaemia. Check your blood sugars when you experience these symptoms.

Avoid eating fatty, fried, high carbohydrate diet. Eat plenty of fresh fruits and XXXXXXX leafy vegetables. Drink enough water. Do daily brisk walking for 40 minutes.

The Barret's oesophagus needs to be serially monitored regularly to note for any dysplastic change. Avoid smoking, drinking alcohol. Avoid eating spicy food. Avoid lying down immediately after meal, but lie after 2 hours of meal. You may lie at 45 degrees from horizontal after eating meal. You may require Proton pump inhibitor drugs to reduce acid secretion.

I hope I have answered your query. I will be available to answer your follow up queries.


Above answer was peer-reviewed by
Follow-up: Hot flushes, dizziness,rapid heartbeat, chest pain, GERD with barrett's esophagus, endoscopy and colonoscopy normal. Hypoglycemia or stress ? 46 hours later
I am a non-smoker.

I take pantoprazole (between 40-80 mg daily) for the GERD. I occasionally take an aspirin or Gas-X as needed.

The chest pain can last from anywhere between a few seconds to a few minutes.

The pain doesn't radiate to the neck or chin - if it does go to the left arm, I don't recall.

I will follow up with the tests that you recommend.

Do you think there could be a neurological issue, or does the follow up information I gave seem to confirm your earlier suspicions?

Thanks again.
Answered by Dr. Aashish Raghu 8 minutes later

Thanks for writing again.

The chest pain can also be because of the GERD but it is hard to confirm without doing an Electrocardiogram first because pain of Gastritis and GERD can present similarly to heart attack pain.

The issue being neurological could be a distant possibility however anxiety can be a differential diagnosis from Psychiatric point of view.

It is because of the varied possibilities that you need to get ruled out for all possible conditions, one step at a time.

Do consult your Doctor, get a thorough evaluation to rule out heart condition, status of GERD and last but not least anxiety as well.

I hope this helps to clear your doubts.

Wishing you good health.

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