Suggest Treatment For Severe Pain In Middle Of Chest

Brief Answer:
I would explain as follows:

Detailed Answer:
Hello XXXX!

I understand your concern and would like to explain that your friend condition seems to be complicated.

As he has a known history of meth use, previous history of pulmonary embolisms and pericardial effusion, it is necessary to perform a differential diagnosis.

A gastro-esophageal reflux is first suspected (as his complaints are aggravated when he lies down). In such case, gastric anti-secretor drugs (like pantoprazole, omeprazole, ranitidine, etc.) would be helpful.

But, also a cardiac ischemia should be carefully sought. A resting ECG and cardiac enzymes (lab tests) are frequently used for getting to right conclusions in this regard.

An esophageal spasm, or sometimes a hiatal hernia may exacerbate such a clinical symptomatology.

But also a recurrence of pulmonary embolism, though primarily is expressed with breathlessness, may be manifested with pain (especially when it is complicated).

And of course, a pericardial inflammation may be associated with severe chest pain, mainly modulated by respiration, posture change and coughing.

In such case a careful physical exam to hear pericardial friction rubs (if no too much pericardial fluid is present) in auscultation may be helpful to differentiate the right responsible cause.

A cardiac ultrasound would confirm pericardial fluid presence.

So, dear XXXXXXX to make it clear and short for you, I am afraid, that all the above mentioned alternatives are difficult to differentiate at home settings.

My personal opinion, if the severe pain persists, though your friend is reluctant to go to the ER, you SHOULD ask 911, as among the above mentioned possible causes there are also very dangerous alternatives not rarely life-threatening (pulmonary embolism, cardiac ischemia).

Hope to have been helpful to you!

In case of any further uncertainties, feel free to ask me again.

Kind regards,

Dr. Iliri

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