Brief Answer:
Muscular pain due to sprain or internal injury

Detailed Answer:
Hi Dear ,
Firstly thanks for choosing health care magic for your query .
As written by you your angiogram(heart XXXXXXX ) was normal.
Coronary angiogram is the gold standard test for diagnosis of coronary artery disease with a sensitivity level as high as 99.9% ,on top of that your stess test was also normal .
so the chest pain and burning sensation is not because of cardiac cause.
There are some other causes which can present with the same symptoms and can mimic pain of cardiac origin
few of them are
gastritis
heart burn
acid peptic disorder
a muscular origin pain
anxiety
As you say your chest pressure and heaviness sensation goes away as soon as you slow down its very likely that pain can be of muscular origin ,it can be a sprain to any of the muscles or a hidden internal injury to muscles of the chest , a thorough evaluation by a physiotherapist or sports medicine doctor is required to see if there is any sprain or internal injury to muscle.

Once confirmed he would prescribe you with some anti inflammatory medicines for few days and would advise you rest!!
As you have not mentioned any history of acid peptic disorder or heart burn ; and your chest pain is directly related to exertion (with angiogram normal) its most likely muscular origin pain.
Another rare entity is Prinzmetals angina also called as vasospastic angina and is due to spasm in coronary arteries but is more common in young(you have not mentioned your age) and occurs usually at rest,but as off now i would suggest you that your history points more towards muscular origin of pain.

If you have any further queries i would be happy to help you,feel free to ask !
Thank you
Dr Rishu Saxena
cardiologist

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Brief Answer:
GASTRO OESOPHAGEAL REFLUX DISEASE

Detailed Answer:
Hi,
As was writen by me in earlier answer
gastro oesophageal reflux disease,acid peptic disorder ,doudenal and gastric ulcers can mimic cardiac pain.

As you say ,you have acid reflux for several years ,most likely cause of your chest heaviness and pain is GERD( gastro oesophageal reflux disease).Gastroesophageal reflux disease (GERD), Also known as acid reflux.
GERD occurs when stomach contents move back into the throat. This may cause a burning sensation in the chest known as heartburn.

Once cardiac condition has been excluded , the most common cause of chest pain is GERD.

As you say you are on acid reducers for many years and currently you are on omprazole only.I would like to say that treatment of GERD is done according to the following guidelines

Patients are often prescribed a proton pump inhibitor (PPI) also called a PPI trial(eg omeprazole). They must be taken at least 30-60 minutes before breakfast.If the patient responds, the treatment can be continued for at least 8 weeks.
For patients not responding to a PPI(as in your case) alone a combination of PPI with Levosulpiride should be tried for 4 weeks.

Low doses from the class of drugs known as tricyclic antidepressants (TCAs) are used in patients not responding to PPI'S and levosulpiride cobination.These medications are felt to produce their favorable effect by reducing pain transmission from the esophagus to the brain. The two most commonly used agents are imipramine and trazodone.

For patients not responding to either acid inhibition trial or TCA , esophageal motility testing (a study done to evaluate the muscle contractions of the swallowing pipe) may be done to look for other uncommon causes of chest pain such as achalasia. Esophageal achalasia is an esophageal motility disorder involving the smooth muscle layer of the esophagus and the lower esophageal sphincter (LES), Achalasia is characterized by difficulty in swallowing, regurgitation, and sometimes severe chest pain and burning sensation.

A peptic ulcer refers to an erosion in the wall of the esophagus (esophageal ulcer), stomach (gastric ulcer) or intestine (duodenal ulcer). These sores’ may cause pain that is referred up to the breastbone and can last for a few minutes to several hours. Eating often relieves the pain although this may aggravate it in cases of a duodenal ulcer,as you are giving a history of acid reflux from many year ,endoscopy should be done to rule out peptic ulcers.

Please discuss all the above mentioned treatment options and differential diagnosis with your gastroentrologist, a number of combinations can be used in people not responding to proton pump inhibitors, kindly discuss them with your gastroentrologist and ask him to add medications as per the treatment plan i have suggested above.


Don't worry your pain is not cardiac or muscular ,its of gastric origin and can be treated very well.

If you want some more help feel free to question ,i would be happy to help you.

If you like the answer and my suggestion kindly rate them.

Thank you
Dr Rishu Saxena
Resident Cardiologist

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