I am having chest heaviness and tightness, and I am unresponsive to inhalers and Prednisone. What could it be?

Question

Hi doctor,

I have been having ongoing chest heaviness and tightness unresponsive to inhalers and Prednisone. My chest X-ray has been normal, and a chest CT scan as well as stress echo and regular echocardiogram. The only diagnosis I have is esophagitis and gastritis, but I have been taking medication for it, and it is not helping. The doctor says I may have costochondritis, but usually, NSAIDs will help, and I tried taking those, but it did not do anything, and I know it is harmful to my GI issues.

Answer 1

Hi,

Welcome to icliniq.com.

Since your doctor has ruled out the respiratory and the medical causes of your chest tightness, possibilities are that of costochondritis or muscular weakness, fibromyalgia, ankylosing spondylitis, rheumatic diseases. There are a few questions I need you to answer: Is there stiffness in your back? Did the doctor check for your chest expansion clinically, and was it less than normal? Is there any family history of ankylosing spondylitis or rheumatic disease in the family? What area of the chest hurt? Is it near the sternum and the back? Or is it generalized? Are there any trigger points from your pain in the back and the chest area? Have you ever tested for HLA b27? Revert with the details, and hopefully, you should get better. This scenario is overlapping many specialties.

Answer 2

Hello,

Welcome back to icliniq.com.

Thanks for the information. Well, ankylosis spondylitis is one of the causes of chest tightness and reduced expansion, and it is quite common in your part of the world. I would suggest you rule once that out in HLA B 27 test. Also, get your vitamin B12 and vitamin D3 levels tested. Their deficiencies can also lead to fatigue. Well, I strongly feel that all of your symptoms could be explained by cervical arthritis now that you have mentioned radiating pain to the arms and back. MRI would confirm costochondritis but before going for MRI, get your other tests done. Isometric neck strengthening exercises (check online for the method). Hot packs. Use a soft pillow. Do not lift heavyweight. Muscle relaxants such as Thiocholchicoside along with tablet Gabapentin should provide you with some relief. Feel free to ask any further questions. As I mentioned earlier is an overlapping area for two to three specialties. I hope to see you get better.