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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest treatment for retrosternal chest pain

Answered by
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Dr. Ramesh Kumar

Gastroenterologist

Practicing since :1986

Answered : 1990 Questions

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Posted on Thu, 2 Mar 2017 in Digestion and Bowels
Question: i have had discomfort just below the breastbone i believe it is related to hiatal hernia/vagus nerve aspect. I have a hiatal hernia I am 70 and have had atrial fib but had ablation at XXXXXXX in 2008 and have Hashimotos thyroiditis i take synthroid for thyroid and i also take toprol 25 er and 50 flecainide twice a day. Its seems when it comes after exercise like i played golf today and i swing pretty hard. I have an alivecor EKG on my smartphone and it is normal and blood pressure is 135/74 heart rate in low 60s. I am in florida now and before i came here from philly had an endoscopy and it showed gastritis i do take prilosec I don't know if there are any other answers for this discomfort it does create some anxiety also.
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Answered by Dr. Ramesh Kumar 2 hours later
Brief Answer:
Can be due to cardiac cause or heart burn due to gastritis!

Detailed Answer:
Hi
Thanks for choosing HCM for your query!

Retrosternal chest pain,Heaviness and discomfort is a characterstic feature of angina pectoris.As per the history it comes after exercise and goes off on resting.Any pain which starts on exertion is retrosternal in nature and is relieved on resting,Should thoroughly be detected for angina.Athough you are a diagnosed case of gastritis and usually heart burn due to gastitis also presents with same feature,But as it is evident cardiac cause is always investigated on top priority because it cam lead to emergency conditions.
Few investigations suggested by me are-
Stress test- to rule out any significant ischemia to your heart.
2d echo-To see if all cardiac functions are normal.
if both these tests are normal then you are free from cardiac side.
Ask your gastroenterologist to add domperidome 30 mg or levosulperide to your PPI(pantoprazole) regimen.They will prevent acid reflux hence will relieve heart burn.An antacid containing local anaesthetic like Mucaine gel could also be added to provide you with symptomatic relief.

Some general instructions to be followed are-
Drink a lots of COLD milk.
Don't drink juices of citrus fruits like orange.
Don't eat spicy,oily and fried food.
Eat simple home made food for a few days.
No smoking or alcohol.

Thanks!
Above answer was peer-reviewed by : Dr. Yogesh D
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Follow up: Dr. Ramesh Kumar 22 hours later
Hi, I have provided some attachments. Please review them.
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Answered by Dr. Ramesh Kumar 21 minutes later
Brief Answer:
Heart burn!

Detailed Answer:
Hi
Your stress echo is normal which clears you from cardiac side.
Just follow what was adviced by me earlier you will start feeling much better in a week or two.
Follow up after 1 week.
Apart from medicines follow-
A low fat diet.
Avoid too much spices or fast food.
Drink COLD milk everyday.
Avoid juices of citrus fruits.
Eat a lots of yoghurt in food.

Thanks!
Above answer was peer-reviewed by : Dr. Prasad
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