What could be done to relieve from chest pain and high BP?

Hi doctor,

I am a 39-year-old male. My height is 6 feet and my weight is 194 pounds. My waist is 36 inches. Around 20 years back, I was heavily into sports and won a gold medal at the national level of athletics.

Nine months before, I was diagnosed with hypertension and occasional mild chest pain or discomfort. I was sleepless, restless, and under the stress of a prevailing family medical emergency. I was asked to take two trop T-tests and they were negative. Then a TMT, which showed some issues at stages 3 and 4.

I could not complete the TMT as my legs were paining because of the fatigue. My cardiologist (C1) said it was a false positive and prescribed me Ecosprin AV 75, Razo 20, and Nebicard 5 mg. After two months, I felt some mild pain and discomfort. I went to another cardiologist (C2) and he asked for an echo, which was normal with mild LVH, 66 percent EF, and grade 1 diastolic dysfunction. But, he said since I smoked for the last 15 odd years, it is better to do an angiogram. A few ECG reports during this time as per the doctor were showing fine.

My first cardiologist (C1) said an angiogram was not required and I literally forced him to do the coronary angiogram as I wanted peace of mind. The angiogram was normal, but it showed a myocardial bridge in the mid LAD causing a 30 percent systolic narrowing. Then, my doctor said it was normal. But, he gave me a whole lot of medicines, including Pinom 40, Ecosprin AV 75, Nebicard 5, Razo 20, and Dilizem CD 90.

Since then, the problem actually started. Earlier, I never had pain in the chest. There was only some mild sensation and discomfort. But now, I have pain in the middle and left side, left arm, shoulder, and back. I was getting very anxious and my BP would fluctuate. I could not work or do anything properly with concentration.

After three months of suffering, I visited my general medicine specialist who stopped all medicines and asked to take only Pinom 40 and Concor 5 for BP and Atorvastatin for lipid though the cholesterol levels were fine. He said that the Ecosprin and Dilizem were causing gastric problems and hence, the chest pain. Also, arranged for me to see a well-known cardiologist (C3) and he asked me to continue only BP medicines and a Pantocid DSR for a month.

He said that it is reflux, which is causing the issue. Since then my pain has been down by almost 75 percent. I saw a gastroenterologist, and he also said that I was suffering from GERD. He did an upper GI endoscopy, which was normal. He also did a Helico test, which was positive as in H. pylori. He prescribed a Pantocid HP kit for 10 days followed by Pantocid 20 mg twice daily for 60 days.

60 days have over and though things have improved, I still get pain in the chest (left side maximum), left arm, and left shoulder. I just do not understand if it is related to the esophagus, then why would there be pain in the left arm and left shoulder pain? Incidence happens mostly in the afternoons. Someone said that it can be musculoskeletal pain. So, I consulted an orthopedician. The gastroenterologist also said that since I get anxious, it always aggravates the pain and the GERD and gave an opinion that maybe I should see a psychiatrist.

I do not know how many more doctors should I see. I am only worried if it is anything to do with cardiac in nature and that is making me nervous and anxious. The cardiologist says that the angiogram is clear. That is conclusive and a gold standard test. I have started doing exercises and yoga since last six months, diet modification, lost around 5 kg weight (do not know if it is because of lifestyle changes or tension), cut down smoking by 80 percent (resolve to quit), and very occasionally drink maybe once or twice a month.

I am on Pinom 40 (morning), Concor 5 mg (evening), and Pantocid 20 mg twice daily. BP is mostly controlled at 130-145/80-90 mmHg. But on occasions where I have chest pain, the BP also goes up. Even after seeing all the good doctors with reputed hospitals, I do not have a complete cure. Will I ever get rid of this problem completely? Kindly help.

Thank you.

Hi doctor,

Thank you for your reply.

I also asked the same of all three of my cardiologists. All of them said that the bridge in my case is only causing 30 percent narrowing, and that too in the systolic phase whereas maximum blood flow happens during the diastolic phase. So, that is nothing at all.

The pain cannot be for the bridge, though all of them had advised me to quit smoking. I told them that I had drastically cut down on it (from 10 to 12 a day to 1 or 2), but they were not satisfied. I just need to be sure that this is not cardiac in nature as that can be fatal.

How can we confirm if the same is the cause of vasospasm, if at all that is the case? Also, would you suggest that I explore the orthopedic angle? Whenever I lift my son holding him close to my chest or I do sit-ups, then also it pains me sometimes in the chest area. Also, is it common or possible that I am having pain in the left arm and shoulder if the cause is GERD? Please advise.

Thank you.