Is chest pain at 23 a sign of heart disease or GERD?

Question

Hello doctor.

I had left-sided chest pain, pain in the left hand and side, palpitations, and a feeling of uneasiness and restlessness. So, I visited the doctor, who advised a 2D (two-dimensional) echo. The echo was normal, and the doctor mentioned it might be costochondritis. He prescribed medication, and my symptoms resolved completely.

However, this year, I started experiencing similar symptoms again, such as chest pain, palpitations, restlessness, dizziness, and uneasiness. I went to the doctor, who asked for an ECG (electrocardiogram). I went to the hospital and had the ECG done immediately, without any rest. It showed sinus tachycardia and hyperacute T waves in leads V2 and V3.

I consulted the doctor again. He advised a troponin I test, which I got done within half an hour of the ECG. The result was negative. Then I visited another doctor, who said the symptoms were likely due to anxiety. He prescribed medications, including Inderal 10 (Propranolol), Rosumac (Rosuvastatin), and Maxmala 50 (Pregabalin and Methylcobalamin), as my LDL (low-density lipoprotein) was 130 and total cholesterol was 209 mg/dL.

I want to understand why the ECG showed hyperacute T waves and tachycardia. Is this normal?

I was very anxious during the ECG. A cardiologist also said it was likely due to anxiety. I also have a history of hiatus hernia and GERD (gastroesophageal reflux disease).

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have gone through your query and understand your concern.

Your troponin I is negative, and your echocardiogram shows no signs of acute cardiac issues. This is very reassuring, especially since your pain was relieved by the medication provided by your physician.

It would have been better if you had shared your ECG (electrocardiograph) with me so I could check for truly tall or hyperacute T waves. Besides ischemic heart disease, other causes of tall T waves include hyperkalemia, which means raised potassium levels in the blood. I suggest a basic metabolic panel, including creatinine and serum electrolytes, to rule out hyperkalemia.

Since you have no other risk factors and your LDL (low-density lipoprotein) is only 130, you only need to adopt a healthy lifestyle to keep your lipid levels within a normal range. You do not need any medication at this point. However, daily walking and exercise, a low-fat diet, and more salads, fruits, and vegetables are recommended. Please replace red meat with chicken and fish, which are healthier options.

As you have a hiatal hernia, which increases the risk of gastroesophageal reflux disease (GERD), I would suggest consulting a gastroenterologist for a more permanent solution. GERD can cause chest pain that mimics cardiovascular pain.

Meanwhile, you can take over-the-counter antacids, Omeprazole 40 mg once daily for acidity, and a prokinetic such as Itopride 50 mg twice daily, half an hour before meals, to help prevent GERD and reduce acidity.

To rule out further cardiac issues, I recommend a treadmill stress echocardiogram, which is more sensitive and specific for detecting ischemic heart disease.

I hope I have answered your question.

Let me know if I can assist you further.

Answer 2

Hello,

Welcome back to icliniq.com.

Your ECG (electrocardiogram) is normal and does not show hyperacute T waves, only sinus tachycardia or a fast heart rate. I assume the rapid heart rate was due to anxiety and stress, so please do not worry. Your ECG indicates there is nothing to be concerned about.

Furthermore, your probability of having cardiac issues is very low, as evidenced by your medical history, normal lab results, and normal family history.

TMT, a treadmill or exercise stress test, requires running on a treadmill while your ECG is recorded. When combined with an echocardiogram at the end, it is called a TMT echo, treadmill stress echo, or exercise stress echo.

Please seek treatment for your hiatus hernia, as we discussed previously. If you still experience pain afterward, consider getting a TMT or TMT echo. Remember that a TMT Echo will be more valuable for diagnosis than a TMT alone.

I hope I have answered your question.

Let me know if I can assist you further.

Thank you.