Please give me some idea on....

Hi
I had a fever in Laos. Three days later I collapsed- heavy feeling in lower legs immediately followed by vice like chest pain and difficulty breathing. All heart tests showed nothing and initially bronchal spasms were diagnosed in retrospect for the first two attacks. Since then the attacks haven't had the severe chest pain but a strange, fluttering, mild burning alternating with a lump like feeling with chest tightness and breathing difficulties. Sometimes this lasts for days. I also have has lightheadedness, tingling in extremeties and headache although this may be due to panicking from the chest symptoms (?). The strangest thing is an alteration of perception that leads to the feeling of the ground being spongy ie I am walking off balance. I have also had an attack preceded by the feeling of an electric shock in my feet.
An endoscopy shows a diverticulum (small) 20cms from incisors but no esophagus inflammation- plus no HbacterPylori. A barium swallow also showes an intermittent hiatus hernia on the laying down portion of the examination.
Ordinary standard blood work is normal- chest xray looks Ok.
The other thing about the chest sensation is that it feels like a good belch would clear it.
As Ive only just returned home and need to wait for a GI appt I am worrying without some idea as to diagnosis. My thoughts are that esophageal spasm is unlikely as I was told it was sharp stabbing pains rather than long lasting lump feelings/ odd sensations but would like clarification on what you think it is. Plus could I be finding breathing difficult from inhaling stomach acid?
Thanks for answering these questions and proposing some diagnosis from this limited information.
Rich

[Kevin Pho, MD]

Tough to say without examination.  I would assume that the heart has been thoroughly evaluated - with a stress test and echocardiogram.

If negative, you can then look for other causes.  GI wise, GERD and esophageal spasm can lead to the symptoms you describe.  I would consider an upper GI or upper endoscopy as an initial evaluation.  You can also consider a 24-hr pH study which is a more definitive test for GERD.

You may also want to look at the pulmonary system as well.  Tests like a pulmonary function test or methacholine challenge test can be considered to evaluate lung function and asthma respectively.

These options can be discussed with your personal physician.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b