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Dr. Andrew Rynne
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Dr. Andrew Rynne

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What causes persistent burning sensation in upper sternum, difficulty in swallowing and dizziness?

Answered by
Dr.
Dr. Suresh Heijebu

General & Family Physician

Practicing since :2010

Answered : 3630 Questions

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Posted on Tue, 6 Sep 2016 in Digestion and Bowels
Question: Hi, for about 3 weeks now I've been a burning sensation in the upper sternum, near the middle of the chest and the right lung, the pain is radiating to the back. After the first week, I started having trouble swalling and that comes and goes. I also have extreme fatigue and lost a bit of weight but that stopped for now (wasnt eating, mnaybe because of stress). I have some sort of vertigo and nausea and cant stay up for very long or I get dizzy.. I sleep a lot and that doesnt change anything. The first week I went to the ER, blood tests okay, chest Xrays ok, they gave me anti-ionflammation medication. then I went to a Gastroencologist and he did a endoscopy and he didnt see anything unusual, I am waiting for biopsy results. My pain is not affected by eating nor exercise but the fatigue and dizzyness is really grinding my gear. I am seeing my family MD monday but I need a second opinion because this is really affecting my quality of life and I feel like I shoul;dnt be waiting on this before it spreads but theres nothing more I can do. Thank you
doctor
Answered by Dr. Suresh Heijebu 5 hours later
Brief Answer:
Esophageal motility disorder has to be ruled out.

Detailed Answer:
Hello, Sir

I can certainly understand your concern.

The symptoms in your case need a further evaluation.

The awaited biopsy report provides a vital information with regards to infectious gastritis ( H pylori Gastritis).

Since there is associated swallowing difficulty, its advisable to get esophageal manometry study.

This will help to rule out esophageal motility disorder.In such cases, the endoscopy can be normal.

The weakness and fatigue could be secondary to impaired digestion and food intake.

Additionally, I advise you to get a complete blood picture, serum vitamin B12 levels and complete thyroid profile.

Further management if any is based on test results.

Meanwhile, I advise oral pills of Nifedepine to improve pain and difficulty in swallowing.This drug can improve the swallowing difficulty if associated with motility disorder.

Please check with your physician if he shares my view and if can prescribe these pills to you.

Vertigo in your case could be related to transient postural dysfunction of vestibular apparatus.A trial of oral pills of beta histine can help.

Kindly update me with test results.

Post your further questions if any.
Thank you.
Above answer was peer-reviewed by : Dr. Veerisetty Shyamkumar
doctor
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Follow up: Dr. Suresh Heijebu 3 hours later
Thank you very much for the fast and helpful response, thyroid tests have been done in the ER and came back normal but I dont know if there are many kind of tests for Thyroid and if it was a *complete* test

The sternum pain that radiate to the back is located more to the right, it feels like it's almost on the right lung, is it normal for oesophegal issues?

I should also point out that I've been having what my family MD suspects to be "oesophagal spasms" for the better part of my life (since im 12 years old as far as I remember) due to stress and anxiety and often have symptoms that ressemble heart attack but the heart tests always come back normal, I am in fact an avid jogger so they are even slightly above average... the problem is with the emotionnal eating habits so I am a bit overweight..

I should also point out that I have frequent palpitations, as well as heartburns while eating or drinking cold/hot liquids too fast. I am awaiting an echo to rule out Pericarditis, but seems to me like that would be a secondary cause in my case...

Lastly, the vertiggo came right after the first symptoms and I never had this in my life, I somehow doubt that it would have anything to do with the inner ear? Could inflammation or infection cause this ?

thank you!

Ps: to help get as much info as possible: I am 37 years old, 250 pounds for a height of 5'11
doctor
Answered by Dr. Suresh Heijebu 32 hours later
Brief Answer:
Possible Achalasia? Need Esophageal manometry study

Detailed Answer:
Hello, Sir

I can certainly understand your concern.

I collected the best possible information resources for you since our last conversation.

As per your chest pain symptoms, the possibility of Achalasia Cardia or Diffuse Esophageal spasm is high.

This can be worsened by heightened emotion or a undue physical activity.

It's pretty important that you get an Esophageal manometry study at the earliest to decide on further therapy.

Complete thyroid test includes measurements of T3, T4 and TSH.

With regards to vertigo, a possible inflammation of the inner ear has to be ruled out.For this I advise you to get electrovideonystagmography test.This will guide you further.

Weight reduction in your case is very important.A reduction is 50 pounds is advisable.

Post your further questions if any
Thank you.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Suresh Heijebu 37 minutes later
Thank you again I will.discuss this with my family MD, last night the episodes of dizzyness and chest pain as well as palpitations came back stronger.. I did some research and found out about cardiac insufficiency... I focused on oesophagal spasms cause my MD talked about it, but the lack of osygen could explain the stabbing pain to the heart, the chest pain around the right lung radiating to rhe back, the dizzyness and also I noticed that with heavy exercise like jogging I am out of breath faster and almost fainted last time. . It would certainly explain the very frequent palpitations.. I am a bit worried now I went to the ER and did some blood tests for heart enzymes but I learned that this only rules out heartattacks but not insuffiency wich is a high risk factor

I also have a very low heart rate (43) at rest but seeing as im a jogger I attributed it to jogging but I still find it very low..

Seeing as it can cause sudden heart failure or death I am a bit worried now , I alreeady have a ecg with effort tomnorow and echo of the heart Wednesday but with last nights episode Im afraid to wait..

Any information on this would be helpful.. thank you!
doctor
Answered by Dr. Suresh Heijebu 12 hours later
Brief Answer:
Cardiac evaluation is useful

Detailed Answer:
Hello, Sir

I can certainly understand your concern.

The likelihood of cardiac disease is low in your case considering your age.

But nevertheless, it's advisable to rule out the cardiac disease.

This certainly requires a combination of ECG, 2D echo and cardiac enzyme marker study for assessment.

These series of tests have high sensitivity and can rule out cardiac disease if any form if they turn out to be negative.

Hence , get these tests and update me with test results.

Post your further queries if any.
Thank you.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Suresh Heijebu 51 minutes later
Thank you ,

ECG on threadmill is tomorrow

Echo is wednesday, I will definitely update you on both these tests :)

Also my MD offered to make a chest MRI even though he doubts that we will find anything, I'm just curious, will that expose any possible bacterial infection or inflammation or else and rule out pretty much everything else? I heard that these tests are much less invasive than the CT scans and even more detailed

Lastly, one additionnal detail I'd like to add.. my girfriend was shy to tell me but after waking up with a very bad taste in my mouth and even rinsing my mouth several times at night I asked her about my breath and she said that it smelled bad since a month.. in the two years we've been together it's never been the case cause I use mouthwash daily

thanks again!


I would also like to point out one last thing... my main concern is the consistant chest pain radiating to the back on my right side, the rest could be stress related but the shortness of breath and dizzyness is very atypical to me...

thank you


Hi, ECG on threadmill was done, I'm 11.5 and the average for my age is 10,5 so very good, and I have sinusal bradycardia wich is normal for a jogger

Echo was done and pending further result but the technician at first glance really didnt see anything abnormal. I think at this point anything cardiac can be ruled out

Here is where I stand for now: awaiting the result of the biopsy of the oesphagus, wich visually was apparently normal

the dysphagia came back though, and today at lunch I felt like food was getting stuck in the troat and a piece seemed to have stayed there for an hour at least. It comes and goes and really is an inconvenience, the chest pain comes and goes as well.

My MD prescribed an MRI of the whole chest, I wonder, will that show any trouble with the oesophagus and/or troat for the dysphagia ?

My next move, as you recommanded, would be

-manometry

followed by:

-barium meal and baryum swallow

I need to get the prescription, will you agree ?

thank you
doctor
Answered by Dr. Suresh Heijebu 2 days later
Brief Answer:
You are heading in the right direction.

Detailed Answer:
Hello, Sir.

Yes certainly I agree with the way you are proceeding in your investigations.

MRI of the chest can prove useful .

Finally its the Manometery and Biopsy that give the final confirmation.

Cardiac causes can be reasonably ruled out.

Post your further questions if any.
Thank you.
Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Suresh Heijebu 52 minutes later
Thank you very much I will keep you informed of the progress for those tests.

Do you think it would be worth seeing an otorhinolaryngologist for the dysphagia and fainting/weakness problems?
doctor
Answered by Dr. Suresh Heijebu 9 hours later
Brief Answer:
Otolaryngologist can be consulted at this point.

Detailed Answer:
Hello, Sir.

Yes, indeed it would be wise for you to see an Otolaryngologist at this stage.

Keep me updated of the health reports.

Thank you.
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Suresh Heijebu 6 hours later
Hi, I am writing o you because last night was a nightmare... I started having very bad chest pain early in the vening, wich I associate with either Oesophegal spasms or something close to GERD, and when I went to bed I started being dizzy, nauseous and having faint spells. The pain in the chest was dull but diffused and I had a huge lump in the troat feeling all this time. I was also short of breath for a while, it oke me up a few times. I was just overall feeling weak and bad, even this morning I feel fatigued and light-headed

I dont feel like simple stress or "mechanical" issues could go that far at this point, the first time I felt that bad was the first time I encountered these symptoms 1 month ago. It really feels like an infection or something that is spreading

The pain is all around the center of the chest and right lung as well as heartburns and also in my throat

I am fearing the worse even if the Gastroenterologist said that he didnt see anything wrong with the gastroscopy and im still awaiting biopsy results

I know it's a long stretch to assume anything but I'm really tired of waiting and suffering, if you have any clue what so ever, even if it's bad, as to what could cause all this, I'd be very grateful, thank you!!


By the way my next appointement with the Gastroentherologist is next friday, the 26th, I will know more by then since the biopsy results will be in... I just hate the wait but I guess I dont have much choice now

I'm only curious if the symptoms ring a bell on your end

thanks!
doctor
Answered by Dr. Suresh Heijebu 14 hours later
Brief Answer:
Manometery is required at the earliest.

Detailed Answer:
Hello, Sir

Your symptoms largely point to esophageal motility disorder.

It's very important that you get an Esophageal Manometery at the earliest to determine the further course of action.

Biopsy can also provide important additional clues.

As earlier said, Oral pills of Nifedepine may help you to acquire symptomatic improvement.

Thank you
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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