Brief Answer:
Cardiac stress test; probably related to stomach

Detailed Answer:
Hello and welcome to HCM. I understand your concern.

Well, good news that EKG is normal. I also think that a cardiac stress test is needed right now. Now, I agree with your doctor that thinks this kind of pain is not related to the heart.

You see, angina (pain derived from blockages of the arteries that supply the heart muscle with oxygen - the coronary arteries) has to be ruled out when we have to deal with a meal patient, with these symptoms, who is above 45 years of age. That is why I suggested stress test, a test which evaluates the heart state during exercise, which has high specificity for coronary disease diagnosis. In the meanwhile, my strongest suspicion goes to the alimentary tract, about these symptoms, mostly the stomach, as this is related to food intake.

So, I would recommend this strategy to be followed: one month of one protein pump inhibitor twice a day (PPI: Omeprazole, Esomeprazole etc.). If the stress test comes back positive, a coronary angiogram is recommended. If it is negative, we would be almost a hundred per cent sure that this is coming from the stomach and the stomach therapy should be continued for the full month. And, if the pain persists even after the one-month course of PPIs, the upper gastro-intestinal endoscopy should be carried out, to take a close look at the alimentary tract mucosae (inner lining), to precisely find the possible problem.

I hope I was helpful and thorough. I am happy to help, if you have follow-up questions.

Best regards,
Dr. Meriton

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