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Suggest Treatment For Constant Chest Discomfort
Question: Hi, am a 34 year old male with slight hypertension. Almost an year back,I started developing some chest discomfort, sometimes while walking and sometimes while sitting as well. I have some discomfort while walking uphill and stairs (tightness/pressure and I get slightly breathless). I had ECG, TMT, Echo test done and all were normal. I visited a cardiologist and he asked me to get a Coronary CT Angio done(March 2016) and I got a normal result with calcium score of 0 and all arteries normal. An year passed by and I couldn't put my mind to rest, I again got a TMT and ECHO done (3 days back) and again it came back normal. I didnt have any symptoms during TMT. Suspecting some problems with lungs, I got a PFT done by a pulmonologist and that too came back clear. I am continuously worried about me having a undetected heart problem. Can someone help me what should be my further course of action? I am taking Prolomet XL 25 (twice a day) for bp and to lower my heart rate which doctor attributes to anxiety. Thanks in advance
Brief Answer:
See the description
Detailed Answer:
hello,
My first possibility at this stage, is gastritis and reflux disease which is common mimicker of heart disease in many individuals.
All your tests are normal, ruling out significant cardiac disease. The typical cardiac symptoms would occur on exertion and relieves with rest, less likely to occur at rest. There is a condition called as microvascular angina, in this condition there is problem in very small vessel and can cause symptoms of heart disease but angiography or echo would be normal. But tmt should have picked it up. I would say, if you have pattern of symptoms like occurring on exertion and relieves with rest, then once you subject yourself to stress thallium. That's the different type of test which is somewhat similar to tmt, to see heart blood supply at stressful conditions at microvascular level. If this is negative, then there is hardly any possibility of heart disease left.
so mostly it's a gastritis and reflux disease. Do you also have upper abdominal pain, nausea, bloating, burping, increase in pain on food, sour water feeling in throat or chest burning, these are other associated symptoms. You should avoid fatty, oily and spicy diet. Have some walk after having food instead of taking rest. Have multiple small meals instead of heavy meals. Have regular sleep habits and avoid stress. Lots of green leafy vegetables, fruits. Elevate head end during sleeping. Avoid smoking and alcohol if any.
You should get prescribed tab Pan DSR 40 mg beforebreakfast once a day for 2 weeks.
Also, you should try using tab Sorbitrate 5 mg sublingually whenever you have any chest pain or discomfort, and if it relieves it then then it will raise some questions and support microvascular angina. Also, it may sometimes relieves the pain of reflux as well. Hope this helps you and get back if you have any more doubts.
See the description
Detailed Answer:
hello,
My first possibility at this stage, is gastritis and reflux disease which is common mimicker of heart disease in many individuals.
All your tests are normal, ruling out significant cardiac disease. The typical cardiac symptoms would occur on exertion and relieves with rest, less likely to occur at rest. There is a condition called as microvascular angina, in this condition there is problem in very small vessel and can cause symptoms of heart disease but angiography or echo would be normal. But tmt should have picked it up. I would say, if you have pattern of symptoms like occurring on exertion and relieves with rest, then once you subject yourself to stress thallium. That's the different type of test which is somewhat similar to tmt, to see heart blood supply at stressful conditions at microvascular level. If this is negative, then there is hardly any possibility of heart disease left.
so mostly it's a gastritis and reflux disease. Do you also have upper abdominal pain, nausea, bloating, burping, increase in pain on food, sour water feeling in throat or chest burning, these are other associated symptoms. You should avoid fatty, oily and spicy diet. Have some walk after having food instead of taking rest. Have multiple small meals instead of heavy meals. Have regular sleep habits and avoid stress. Lots of green leafy vegetables, fruits. Elevate head end during sleeping. Avoid smoking and alcohol if any.
You should get prescribed tab Pan DSR 40 mg beforebreakfast once a day for 2 weeks.
Also, you should try using tab Sorbitrate 5 mg sublingually whenever you have any chest pain or discomfort, and if it relieves it then then it will raise some questions and support microvascular angina. Also, it may sometimes relieves the pain of reflux as well. Hope this helps you and get back if you have any more doubts.
Above answer was peer-reviewed by :
Dr. Remy Koshy
Thank you doctor for prompt response.
I don't have abdominal pain, but I get frequent burps and belching. Sometimes I have nausea on empty stomach. I feel a sour liquid coming out in my throat many times. I am on a very strict diet thinking I have a heart disease, I have avoided sugars and fatty food from a very long time.
I do a bit of jogging/exercise in the morning and sometimes don't have any problems. Yesterday I was watching a movie after lunch and I had some discomfort. After the interval, it suddenly went away.
I have tried Pantocid DSR last year thinking it was gastritis and it had helped very slightly.
I am not sure if I can get a stress thallium test without a prescription. What would you advice?
I don't have abdominal pain, but I get frequent burps and belching. Sometimes I have nausea on empty stomach. I feel a sour liquid coming out in my throat many times. I am on a very strict diet thinking I have a heart disease, I have avoided sugars and fatty food from a very long time.
I do a bit of jogging/exercise in the morning and sometimes don't have any problems. Yesterday I was watching a movie after lunch and I had some discomfort. After the interval, it suddenly went away.
I have tried Pantocid DSR last year thinking it was gastritis and it had helped very slightly.
I am not sure if I can get a stress thallium test without a prescription. What would you advice?
Brief Answer:
See the description
Detailed Answer:
Your symptoms are very suggestive of reflux only. I think we should first treat reflux then go for stress thallium. However, you can try getting stress thallium from nuclear medicine department and you can discuss the issue with your local doctor and request him for thallium scan.
You follow dietary and behavioral measures which I have suggested in earlier discussion. Reflux is chronic problem and may need a medicine for longer time and in higher doses. I would suggest, you change the salt, use Tab Rabpill LS (Rabeprazole plus levosulpiride combination) 20 mg beforebreakfast in the morning continue this for 3-4 weeks and only Tab Rabpill 20 mg in evening before dinner for a week for tighter controls. Also, use some local agent like Syr sucral O or gelusil two teaspoon three times a day for a week. You can get one urease breath test done in order to rule out stomach infection which is a common cause gastritis. You can also visit gastroenterologist for the same. Get back if you have any further questions.
See the description
Detailed Answer:
Your symptoms are very suggestive of reflux only. I think we should first treat reflux then go for stress thallium. However, you can try getting stress thallium from nuclear medicine department and you can discuss the issue with your local doctor and request him for thallium scan.
You follow dietary and behavioral measures which I have suggested in earlier discussion. Reflux is chronic problem and may need a medicine for longer time and in higher doses. I would suggest, you change the salt, use Tab Rabpill LS (Rabeprazole plus levosulpiride combination) 20 mg beforebreakfast in the morning continue this for 3-4 weeks and only Tab Rabpill 20 mg in evening before dinner for a week for tighter controls. Also, use some local agent like Syr sucral O or gelusil two teaspoon three times a day for a week. You can get one urease breath test done in order to rule out stomach infection which is a common cause gastritis. You can also visit gastroenterologist for the same. Get back if you have any further questions.
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Kampana
Answered by
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