What can cause chest pain?

Question

Hello doctor,

Last night and today, I have been experiencing sharp pain just to the left of my sternum. The pain is not deep; it seems to be on top of the rib where it joins the sternum. It lasts for a second or two but may repeat several times before stopping after about five minutes. I went out to the garden today to do some digging and wore my heart rate monitor (I have health anxiety, anxiety disorder, and depression). As I was digging, the pain intensified with each heartbeat. I checked my monitor, and it read 138 bpm. I am 70 years old and have been on medication (benzodiazepines) for over 50 years for panic attacks and general anxiety.

Two years ago, I felt similar pain, but not to this extent. I went to the ER, but nothing was found. The doctor said it could be costochondritis but definitely not a heart issue. I have bloodwork done quarterly, and everything was fine except for my cholesterol, which was 235. I tried a statin, but the muscle pain was too great. My EKG shows a right bundle branch block (RBBB) or left anterior fascicular block (LAFB). Fourteen years ago, after a stress test, I was told that I was probably born with it. I consulted a cardiologist then because I was experiencing skipped beats and GERD; he advised me to ignore them.

The last time I had an EKG was six months ago in the ER when I experienced unusual pain in my back and side. They checked my heart and said it was fine, probably just a colicky gallbladder. I have had gallstones for over 20 years and have not had surgery, so I hesitate to go to the ER again. My local doctor has just closed. My heart rate is currently 88 while lying down. Usually, my resting heart rate is under 67. I am currently taking 2 mg of Lorazepam, 15 mg of Lansoprazole, and baby Aspirin.

Please suggest.

Answer 1

Hello,

Welcome to icliniq.com.

I have reviewed your history, and it does not appear to indicate ischemic pain. Ischemic pain is typically not sharp and usually lasts longer. Therefore, the possibilities include costochondritis and pleuritic or pleuro-pericarditis. Do you experience increased pain when pressure is applied to the same site? If so, this would support a diagnosis of costochondritis.

Additionally, do you have any history of recent upper respiratory tract infections, such as a cough, rhinitis, fever, etc.? If yes, this points toward pleuro-pericarditis, which is an infection of the lining of the lungs and heart, typically viral and self-resolving. Another possibility is gastritis or reflux disease. Do you also experience upper abdominal pain, nausea, bloating, burping, increased pain when eating, or a sour taste in your mouth, along with burning sensations in your throat or chest? These symptoms may also be associated.

An increase in heart rate is likely due to anxiety, pain, or a reflex to pain. Please provide more details about the symptoms mentioned above. In the meantime, you should be prescribed some NSAIDs (non-steroidal anti-inflammatory drugs) for this pain, along with antacids. I recommend taking Naproxen 250 mg twice a day or another option like Ibuprofen, along with a combination of Pantoprazole or Esomeprazole and Domperidone before breakfast once a day for five days. Overall, it does not seem to be a matter of concern; however, it is advisable to get examined by a local doctor.

regards.

Answer 2

Hello,

Welcome back to icliniq.com.

This should be resolved with Ibuprofen in a few days. You may also use Diclofenac gel for local application twice a day. For your anxiety, you should also request Propranolol, which will help with anxiety and also keep your heart rate down. Avoid heavy activities until this settles, especially lifting heavy weights. Try to engage in other activities and hobbies to reduce your focus on health and anxiety.

Overall, as I mentioned, it does not appear to be ischemic pain. Ischemic pain usually occurs with exertion and is relieved by rest, typically lasting for at least 5 to 10 minutes. While ischemic pain may occur at rest, if one has a heart attack and it is severe, the pain lasts for a longer duration. Pain lasting only a few seconds may be due to costochondritis, pleuritis, or esophageal spasms with acid reflux.

Additionally, you should avoid fatty, oily, and spicy foods. Take short walks after meals instead of resting, and opt for multiple small meals rather than heavy meals. Maintain regular sleep habits, and avoid smoking and alcohol, if applicable.

I hope this helps you.

Thank you.