I am a 65 year old male who suffered a heart attack four years ago and had a triple by-pass operation. I recovered well and have reasonable heart function (EF about 50%). I have mild angina on exercise. I am taking all the normal CHD medication (aspirin, beta blockers, nitrates, ACE inhibitors); my blood pressure is low (110/65) as is my blood cholesterol.
Every few months I suffer a prolonged 'attack' lasting about a week which involves the following symptoms:-
i) generalised tightness and discomfort across the chest that intensifies on breathing deeply, (ii) episodes of burping (usually when standing and moving after lying down), (iii) periods of inability to burp, (iv) a constant raw feeling in the left chest, (v) aching pain in right and left arms, (vi) periods of indigestion not relieved by gaviscon, (vii) gurgling noises from stomach and abdomen after eating and drinking, (viii) periods when it is difficult to speak at normal volume, (ix) tingling in hands and feet. All of these symptoms are spasmodic except for the chest discomfort which is almost continuous. The symptoms are partially relieved by bedrest and typically disappear after about 7 days.
The attacks seem to be provoked by a period of intense activity combined with some anxiety or stress.
My cardiologist is not sure whether they are cardiac in origin. He referred me to a gastroenterologist who did an upper GI endoscopy (when asymptomatic) and oesophageal manometry. This showed no abnormalities except for "moderate erythematous/exudative gastritis involving the antrum".
The symptoms resemble the features of my original heart attack and I am worried that I may be having a series of minor heart attacks. ECG and blood enzymes tests seem to rule this out (although they were also normal when I had my original MI, revealed only by an angiogram).
I would be very grateful for any advice you can offer as to possible aetiology and appropriate investigations.
I agree with the workup thus far. The upper endoscopy and manometry would exclude many of the possible upper GI symptoms.
You can consider imaging the abdomen with a CT scan or ultrasound to evaluate the liver or gallbladder.
If the heart continues to be of concern, a nuclear stress test or catheterization would more conclusively exclude cardiac disease.
These options can be discussed with your personal physician.
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