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Dr. Andrew Rynne
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Dr. Andrew Rynne

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Suggest treatment for chest pain and anxiety

Answered by
Dr.
Dr. Sagar Makode

Cardiologist

Practicing since :2013

Answered : 1800 Questions

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Posted on Thu, 16 Feb 2017 in Hypertension and Heart Disease
Question: Hi, I am 19 years old and I have been to the emergency this past week for chest pain, tightening of chest and trouble breathing. After the doctors running tests they decided that it was related to stress and anxiety and prescribed me 0.5 mg of Ativan. I have taken the medicine as needed like I was recommended and I have felt no relief. I have trouble breathing and I am not able to lay down without serious pain in my upper back and I am completely unable to take a full breath anymore. I am not sure what to do. I don't know if I should wait and make a doctors appointment or if I should return to the ER and try to find an answer. I had an X-ray and they ruled out any risk of a blood clot on my lung. I'm not sure what to do but I have no relief and I am unable to sleep and relax because of the pain and inability to take a full breath. Please help.
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Answered by Dr. Sagar Makode 48 minutes later
Brief Answer:
Needs some medicine and investigation

Detailed Answer:
hello,
first priority is to find out the cause.
There are two possibilities I can think from this information.
First a problem of lung linings, a pleural pathology, where you get sharp pain and increased on deep breathing. At this point we should consider viral pleurisy as first possibility.
Secondly, it can be a spinal problem leading to compression of nerves between the two vertebrae. Do you have any tingling, numbness or burning sensation along with this, does it increase on movement as well, if yes then it supports the diagnosis.
X ray is very basic investigation and it can be normal in many pathologies.
I would advise for nsaids class of drugs and you should get tab ibuprofen 500 mg twice a day after food along with antacid like pantoprazole 40 mg beforebreakfast once a day prescribed from local doctor. If it doesn't respond then we might need to add tab pregabalin 75mg bedtime and further investigate.
We would wait for 2-3 days then if doesn't respond then you will need ct scan. Get back with more detailed symptoms like exact site, aggravating and relieving factors for the pain or if you have any doubts.
I guess you don't have any wheezing or history of inhalers use. Also, you don't smoke.
Regarding the possibility of clot in vessel, first you need to have risk factors like prolonged bed bound state, swelling in legs and x-ray is not adequate investigation to rule it out, you will need ct pulmonary angiography or v/q scan.
Above answer was peer-reviewed by : Dr. Nagamani Ng
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