What Causes Acute Pain And Tightness In The Chest?

Question : Sir,
I am 62. I came to USA 2 months back. I was on (1)Telma AM (40 mg + 5 mg) (2) Nebicard 2.5 mg (3) Jupiros (10mg+75 mg Aspirin) and (4) Roliflo OD-2 for BPH before I started from XXXXXXX I had been taking a walk for 20-25 minutes here in USA where there are some slopy and ascending tracks. I had been exercising oncross-trainer machine also for 15 minutes or so. One week into this, one day while returning from an ascent ( I had hardly walked for 1.5 KM) I felt something strange in my body (no chest pain, but some heavyness and weakness alongwith some light-headedness). I sat for 5 minutes and restarted and reached my home but the strange manifestation continued for 1-2 hours. I was scared and almost discontinued my walks. My HR used to be very low around 50 and on some couple of days, it read even 47 or 48. I contacted a general physician here who discontinued the Nebicard 2.5 mg and added 5 mg Amlodepine to my list. He also prescribed some Food Supplements such as Adrenaline Cortisol, Vitamin D-50000 IU (per week) and Saw Plametto (for BPH). But I kept on taking my earlier medicines minus Nebicard as well as the additional dose of 5 mg Amlo. I kept my BP charting (twice a day) and for one week, the readings remained between 130 mg Systolic and 80-85 mg Dystolic BUT weakness and light-headedness continued. One day, my children took me to a family get-together whereby I missed my morning dose of Telma AM. When I returned in the evening, I was feeling un-steady and found my BP reading 151/96 and HR 72. Half-hrly readings kept on going up (although I took my missed medicine) to 163/100 and 164/100 with HR as 77 and 88. Following day was almost OK but third day, the BP readings shot to 170/107 and 167/102 with HR as 90 and 92. Thinking that the Supplements might be responsible for heightened BP, I discontinued their intake. For next twenty days, although the BP readings hovered around 150 Sys and 94 Dys, I had lot of discomfort in my chest especially in the thoracic diaphragm area. I had 3-4 episodes of palpitation also during this period. I MAY ADD THAT LAST YEAR IN JULY 2015 I UNDERWENT ANGIOGRAPHY AT XXXXXXX IN ORDER TO RULE OUT ANY PROBLEM AND ALSO BECAUSE MY TMT WAS BORDERLINE POSITIVE. THE ANGIOGRAM WAS NEGATIVE WITH FINAL IMPRESSION AS "INSIGNIFICANT CAD".
I again consulted the same general physician inUSA and told my history of last one month. He has added Toprol 25 mg OD (starting with half a tablet per day and in case things dont improve, then to start full pill). I took the half tablet (alongwith all other medicines prescribed by this Physician minus Nebicard and supplements) last night and felt a bit better in the sense that though there was no palpitation and much heaviness in the chest, I felt my head as heavier with sleep difficult to come but somehow I could sleep for 4 hours or so. Pertinent to add here that I had had couple of episodes of AF in the past in XXXXXXX also that is why Nebicard 2.5 mg was introduced about two years back. I am a case of Bradycardia and generally my pulse reads around 65 or so. Sometimes, I feel lot of pressure in my chest. I started Nexium 20 mg (esomperazole) OD (one hour before main meal of the day) and 3-4 days I felt some improvement in the chest pressure. While I had been preparing this note, I have returned to XXXXXXX I took one 5mg Amlo at 9.30 am in the morning, then took Nexium before lunch which i had at a dhaba on GT Road and half an hour after meal, I took Metoprolol (toprol). I reached my place at 4.00 pm from XXXXXXX and i just carried/lifted 9-10 kg weight brief case to my first floor residence and have been feeling tightness in my chest for the last threee hours or so. My BP measured 113/66 and HR 56. I am not able to figure out what is causing this tightness or pressure in the chest. In between I have to burp also sometimes mildly and few times deeply.
Kindly advise:
i) How do you prescribe my present condition
ii) Can I continue my walks and/or cardio exercises
iii) Is TelmaAM (40 mg Telmisartan and 5 mg Amlodepin)plus another dose of 5 mg Amlodepine and addition of 25 mg Toprol (half pill or full pill) not on higher side considering my XXXXXXX cardia
iv) In fact, you may find me in a catch-22 situation. If I take Beta Blocker, my pulse rate comes down and if I dont take, it causes palpitation.
v) What is your considered advice in my situation

I did not say that the tightness in the chest continued for 34 hours. I said that the tightness started at 4.00 pm moved to the abdominal area after 4-5 hours and remained stuck up in the left side of the stomach where, I think, colon is there and disappeared after I relieved myself in the next morning. The following day was fine. Nexium 20 mg (esomeprazole) bought in USA is surely providing some relief in the matter of tightness in the chest. I would definitely be going to a medical facility in the coming week but meanwhile wants to know from you the answers to the points raised by me in my original question. As you may observe, my main problem is the unstable BP charting and unstable HR (as low as 50 or below and as high as 88-90 even at rest) including few episodes of palpitation as mentioned in detail in the original question.

Thanks for the reply.
As you may find in my original question, I underwent angiography in July, 2015 which was found to be normal. This was my fourth angiography. Kindly recall reply given by you last year when you observed that why I had undergone too many angiography procedures. My anxiety is that when i) i had normal arteries a year back ii) have been maintaining healthy cholestrol levels by regular intake of rosuvas; iii) have been doing yoga one hour daily (while in India) for almost six months and iv) had been taking walk for 2 kms or so 3-4 times a week THEN WHY I FACED THE SYMPTOMS DEVELOPED WHILE IN USA. My HR in USA even touched 47 beats per minute. Even at 50 HR, I used to have low/depressed mood. Lipid prodile done in USA two months back indicated total cholesterol as 118; LDL as 56 and Trigylcerides as 144. Cholesterol/HDL ratio as 3.6. Of course, HDL was just 33.
As you kindly observed last year, my TMT and stress thallium used to be false positive but since stress thallium done in april 2014 showed moderately positive, on the advice of a XXXXXXX Cardiologist of XXXXXXX (personally known to me), I underwent angiography last year despite your advice to the contrary.
Of course, I am going to consult a Cardiologist in XXXXXXX coming week for proper assessment of my medical condition BUT KINDLY OPINE WHAT COULD BE THE CAUSE OF MY SUFFERING SO MUCH THAT I HAD TO RUSH BACK TO XXXXXXX THOUGH I WAS SUPPOSED TO STAY THERE WITH MY CHILDREN TILL MARCH 2017.

My Physician did my ECG as also a Prop T test on Monday. While no changes have been observed in the ECG except bradycardia, the Prop T showed negative.Today, I consulted a XXXXXXX faculty of cardiology at PGI XXXXXXX He has stopped Metoprolol altogether and advised Telma AM twice a day-Morning and Evening apart from Nexium 20 mg (esomeprazole)and has further referred me to G.E. Clinic which i will do shortly. Does this mean that my problem basically linked to the abdominal upset or is still there any scope or need for investigation of any cardio related test(s).