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Suggest treatment for pain under the clavicle

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Posted on Mon, 29 Jun 2015
Question: Hi, about last five days ago I started to experience what I can only describe as a nearly continuous burning pain under the left collarbone (clavicle) followed by a feeling of discomfort in my chest/stomach similar to heartburn, sometimes accompanied by mild headache and cold sweat.I'm 42 years old, slightly overweight and with a previous clinical record of peptic ulcer. I never suffer any cardiopathy but there are previous antecedents in my family that make me wonder.
Thank you in advance for your help.
doctor
Answered by Dr. Bonnie Berger-Durnbaugh (3 hours later)
Brief Answer:
May be acid reflux (GERD) but should be seen to rule out cardiac cause.

Detailed Answer:
I am sorry you are feeling ill with this.

People come in to the ER or Urgent Care clinics all the time with exactly what you are describing, as it is not obvious whether it is gastroesophageal reflux as a cause or a cardiac cause.

In general, GERD causes more of a sharp type pain whereas heart problems are more a feeling of pressure. But not always.

I would strongly advise you go in to be seen while you are having this. Especially because of the description of cold sweat you are experiencing.

If you go in, they will do an EKG which can show if there is heart strain (S-T elevation on the tracing). They will also draw your blood to see if you are having elevation of certain enzymes in the blood which can go with heart strain too. They may keep you over night so that they can draw the "cardiac enzymes" in a series over several hours.

I do not want to scare you about heart problems, and the most likely cause is acid reflux, which may be better treated with an H2 blocker such as ranitidine (Zantac in the U.S.) or a proton pump inhibitor medicine such as omeprazole. Just a side note - newer research is indicating that while proton pump inhibitors may have a stronger effect than H2 antagonists, they also have a potential for a nasty rebound effect. So I tend to recommend Zantac 150 mg twice a day. If the docs in the ER or clinic think your symptoms are from GERD, and you prefer to go with an H2 blocker, they may prescribe it in an even higher dose.

I hope this information helps. So go in - now - and be evaluated to sort this out definitively.

Please let me know if there is further information I can provide.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Bonnie Berger-Durnbaugh (21 hours later)
Thanks Doctor,
I followed your advice and visited a hospital. After some long hours and several tests I've been discharged as there wasn't any clear sign that linked my ailment to heart strain. I've been advised though,to follow up with some extra tests (treadmill) in order to rule out any possible heart condition.
Thanks again for you helpful reply.

Kindest regards XXXXXXX
doctor
Answered by Dr. Bonnie Berger-Durnbaugh (2 hours later)
Brief Answer:
I am glad you followed up.

Detailed Answer:
Thank you for going in to the hospital, XXXXXXX It is impossible to tell the difference between cardiac and gastric caused pain sometimes. The exercise stress test (treadmill) will give useful information.

Best regards to you,
Bonnie Berger-Durnbaugh, MD
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Bonnie Berger-Durnbaugh

General & Family Physician

Practicing since :1991

Answered : 3138 Questions

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Suggest treatment for pain under the clavicle

Brief Answer: May be acid reflux (GERD) but should be seen to rule out cardiac cause. Detailed Answer: I am sorry you are feeling ill with this. People come in to the ER or Urgent Care clinics all the time with exactly what you are describing, as it is not obvious whether it is gastroesophageal reflux as a cause or a cardiac cause. In general, GERD causes more of a sharp type pain whereas heart problems are more a feeling of pressure. But not always. I would strongly advise you go in to be seen while you are having this. Especially because of the description of cold sweat you are experiencing. If you go in, they will do an EKG which can show if there is heart strain (S-T elevation on the tracing). They will also draw your blood to see if you are having elevation of certain enzymes in the blood which can go with heart strain too. They may keep you over night so that they can draw the "cardiac enzymes" in a series over several hours. I do not want to scare you about heart problems, and the most likely cause is acid reflux, which may be better treated with an H2 blocker such as ranitidine (Zantac in the U.S.) or a proton pump inhibitor medicine such as omeprazole. Just a side note - newer research is indicating that while proton pump inhibitors may have a stronger effect than H2 antagonists, they also have a potential for a nasty rebound effect. So I tend to recommend Zantac 150 mg twice a day. If the docs in the ER or clinic think your symptoms are from GERD, and you prefer to go with an H2 blocker, they may prescribe it in an even higher dose. I hope this information helps. So go in - now - and be evaluated to sort this out definitively. Please let me know if there is further information I can provide.