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Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 35491
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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My 82 year old mother recently fell and landed on her back,

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My 82 year old mother recently fell and landed on her back, hitting her head. Surprisingly, the one thing she complained about was chest pain. She was taken to the emergency room, where several xrays and an EEG and an EKG were performed. She had no broken bones. The blood pressure readings were of more concern. There was a 20 point difference in her blood pressure readings when she stood up over when she was sitting down. This would seem to be the obvious reason she was falling. However,the pain in her chest, as far as what has been told to me, has nothing to do with her heart. I've been told she has an "enlarged esophagus". I've tried to find out something about this and find that most of the information available has been for cats and dogs! I did find some information about injury to the esophagus causing pain under the sternum and across and above the breasts, but nothing more.
What is an enlarged esohpagus and just how serious is it? What can I ask at her doctor's appt?

Greetings.

The commonest cause of enlargement of the esophagus is Achalasia cardia. There is a nerve problem of the food pipe (esophagus) which enlarges it as food pents up there. Please read about this condition;

http://emedicine.medscape.com/article/363551-overview

This is not related to fall and may be an incidental finding, though it can cause chest pain. Fall may have precipitated or aggravated the symptoms.

Please feel free for your follow up questions.

Dr. Arun

Customer: replied 7 years ago.
I'm sorry to be so long in replying, but I've been reading and thinking over what you had said about my mother's condition. This is brand new territory. Her chest is hurting more today. What can be done to ease this? Also--are there basic questions you think would be valuable to ask to get a handle on where she is with this disease when she sees her doctor about this? It will be for the first time. I realize that you are not here to examine her or in a position to know everything, but if you think there are general questions I should ask, I'd appreciate it. Thank you. You have already been a great help to me.

You are very welcome.

One of the symptoms associated with the condition is bad breath and regurgitation of the food. So that need to be inquired and ascertained. A condition called as costochondritis will have a local tenderness at the pain site. Following are the non cardiac conditions (obviously echocardiography additionally should be performed with the cardiac enzymes by the blood work to categorically rule out any heart association);

1) GERD with the history of reflux would be prime consideration as it is one of the commonest cause for non cardiac chest pain.

2) Hiatus hernia

3) Esophagitis

4) Costochondritis; it is inflammation at the junctions of rib and cartilage or with the breast bone / sternum. Local analgesic ointment, or spray, chest brace and warm compresses with Ibuprofen is helpful. Another possibility is muscle sprain. Please read about the costochondritis;

http://www.mayoclinic.com/health/costochondritis/DS00626

5) Esophageal spasm

6) Pleurodynia

7) Polychondritis

Investigations like Barium esophagogram, Esophagogastroduodenoscopy (EGD; camera exam), Esophageal manometry, Ambulatory 24-hour pH monitoring may be the next step of evaluation by your doctor. Anxiety and stress can increase any condition. Chest x-ray is helpful for pleurodynia and polychondritis and if not already done should be ordered.

It is pleasure and privilege assisting you.

A very happy new year to you.

Dr. Arun

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