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Do I feel chest pain due to gastric problems?

Q: I am a 39 year old man, 5'3 tall and weigh 48 kg. Nine years ago I had severe chest pain and had undergone TMT and ECG. The tests were normal and the doctor suspected a chest muscle pull. In between I used to have mild to severe chest pain due to gastric problems. Again two years back, I had severe pain and again had undergone echo and TMT tests. The tests were normal and the doctor suspected a muscle pull. Over last 8-9 years I am having mild chest pain at least 3-10 times a week. The pain goes away after I take some antacid. I exercise regularly and have been able to take the heart rate up to 170-180 without any uneasiness. I jog and sprint on a daily basis. Few days ago I used a skipping rope for 60 skips. Next day around 60 skips. Around same time, since last 8-9 days I have some kind of soreness (ache) on my left chest. If I touch it sometimes I feel pain. Otherwise I am OK. However, I am constantly conscious of this feeling of ache (soreness) of my chest. So I have stopped exercising to give my chest muscles some rest lest it is a muscle pull or sprain. I was a smoker for almost 6-7 years smoking 7-10 cigarettes a day. For the last six years, I have not even smoked once. I have never had any kind of alcohol in my life and I am a vegetarian by choice. I have taken only fish once or twice in my life time. I avoid any oily food, fast food and also avoid any kind of diary products. Why do I feel chest pain? Does it require any investigation? Is it anything related to heart problem? What should I do to avoid gastric problems?

A:It appears that you have very healthy habits and you should be commended for that . The chest pain from your description sounds musculoskeletal in origin as you have guessed. However the association with stomach acid may mean you have gastroesophageal reflux or esophageal spasms causing the pain. It would be helpful to try a course of proton pump inhibitors like omeprazole for 2 weeks to see if there is a difference, check for the Helicobacter pylori infection that can cause peptic ulcer disease and also meet with a gastroenterologist to discuss more comprehensive management of the acid problem and the possibility of oesophageal spasm. Also, a chest radiograph would be a good start to look for conditions like hiatal hernia. If the pain is not better a CT scan of the chest may needed but you should make that decision after seeing the gastroenterologist and also having the chest radiograph reviewed by an expert local radiologist in consultation with your main family doctor or internal medicine doctor.

Given your age your age and prior smoking history you are still at risk for other cardiac conditions and should make sure you have normal blood pressure and normal lipid profile. Other simple measures like raising the head of the bed to prevent acid reflux and also not lying down for at least three hours after eating may help. As you know this is general advice based on the limited information provided and you should use this discussion to help guide your local providers in making decisions on how to deal with the pain- maybe acetaminophen would be one choice .Thank you again for writing and keep up the healthy habits !

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