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Dr. Abby
Dr. Abby, Board Certified MD
Category: Health
Satisfied Customers: 10330
Experience:  Family Physician, practicing medicine for over 10 years, United States
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About 4 weeks ago I had a terrible pain right below the sternum

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About 4 weeks ago I had a terrible pain right below the sternum after dinner. It lasted about 20 minutes. A few days later another pain below the right rib cage that lasted 4 days and then switched back to below the sternum. I could barely move with out the pain. Lately the pain is like indigestion with constant pain on the left upper side of my body, making it difficuld to take a deep breath with out pain. It often moves up across my leaf shoulder and can be felt in my upper left back. Although I do not have any pain in my arm sometimes it feels like it is getting numb ar tingles. My gall bladder was removed last year. My doctor ordered an abdominal CT that showed nothing significant, although he ordered the test with IV contrast they did not perform the test correctly and did not adminster the contrast, only oral contrast. He said if I was not better by this Friday he would order an endescope exam. He has me taking Malox tablets 3 times a day befor meals and Prolosec OTC once daily
Submitted: 7 years ago.
Category: Health
Expert:  Dr. Abby replied 7 years ago.

I am sorry that this is happening.
Is the pain worse after you eat?
Did your doctor do an ekg? chest xray?
Lastly, could you clarify exactly what your question is for me today?

Thank you,

Dr Abby
Customer: replied 7 years ago.

He has not done an EKG or Chest X-Ray as of yet. I have a yearly stress test with my cardiologist and that was just a few short months ago.

The pain is constant and eating does not affect it at all. It feels like indigestion but is starting to worry me because of the left sided pain.

I just was wondering what it might be causing the pain.

Back in September I re join a gym and up until last week was going several times a week with out any problems. I could get my heart rate up to 140/150 on the treadmill with out any problems.

Expert:  Dr. Abby replied 7 years ago.
Thank you for the additional information,

Since you had a normal stress test recently, it is unlikely to be your heart (although stress tests are not perfect). I would consider having an EKG done at your doctor's office just to make sure there have been no changes from your previous. If it looks the same as your last, that would add additional reassurance that this is not cardiac.

Indigestion can lead to esophagitis (inflammation and irritation of the esophagus) which can cause left sided or central chest pain. The pain can be constant.
It will take time for the inflammation to heal (2 weeks or more) and the omeprazole is an appropriate medication for this. An endoscopy is required to actually see the irritation.

Another possibility is costochondritis, although this usually does not cause a burning type of pain. If your pain is reproducible when you push on the the chest (along the left side of the sternum), this is a more likely cause of your symptoms. It is due to inflammation of the junction of the cartilage and bone. Treatment for this is ibuprofen (but can make acid reflux or peptic ulcer disease worse).

The third possibility is pleuritis. This is inflammation of the lining of the lungs, usually due to a virus. Pain is worse with deep breathing and is described as sharp. Treatment for this is ibuprofen as well.

If your pain is worsening, I would return to your doctor sooner rather than later and at least have an EKG and possibly a chest xray. Avoid caffeine, chocolate and peppermint--these can all increase acid reflux. Elevate the head of your bed at night if you can.

If you start to develop shortness of breath, sweating, nausea and vomiting along with chest pain, go to the emergency room.

Feel free to ask any follow up questions you may have. I hope this is helpful information for you.

Dr Abby

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Customer: replied 7 years ago.

I had read about a heart condition that mimics heart burn.

Could you tell me about this?

Expert:  Dr. Abby replied 7 years ago.
I am assuming you are taking about heart attack...
Many people think that they are having indigestion when in fact they are having a heart attack because the symptoms are similar--chest tightness/burning/nausea.

Again, the fact that you have had a normal stress test makes it less likely that you are having a heart attack. Plus, chest pain from a heart attack does not last for 3 weeks.

Angina, which is chest pain due to a blockage in the arteries that supply the heart muscle, can mimic heartburn as well. The pain is usually brought on by exercise or exertion and relieved with rest.

Esophageal spasms can mimic heart attack as well.

Again, if your pain is worsening I would at the very least have your doctor do an ekg for comparison to an old EKG. It is unlikely that this is cardiac related due to your recent normal stress test but stress tests are not perfect.

I hope that answers your question for you. If you have other questions, let me know,

Dr Abby

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Customer: replied 7 years ago.
Does angina cause pain with simple movements like standing from a sitting postion, or turning from one side to the other when lying down? or is this more likely the esophageal pain?
Expert:  Dr. Abby replied 7 years ago.
No, usually angina is with more exertional types of activities (stairs, brisk walking, exercise).

If you have pain with shifting positions, there could be a muscular component to it.

Another possible cause of your pain (although not common) is something called pericarditis. This is inflammation of the lining of the heart. With pericarditis, the pain can radiate to the back. The pain often feels better if you lean forward. It may feel worse with deep breathing. An EKG can usually diagnose this. It is often viral but autoimmune diseases and other things can also cause it.
This may be the condition you were asking about above.

Again, I do think an EKG should be done as part of your workup.
Let me know if more questions,

Dr Abby

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