Random Chest Pains, Becoming Worse!!!

  I am a 31 year old male, 6'0, 285lbs, diagnosed with GERD about 4 years ago. I'v been taking Prevacid for most of that time. While it takes care of my heartburn symptoms if taken as perscribed, I have been plagued with Angina like chest pains for about 3 years now. It comes on and typically last about a week, varying in severity. Since I'm overweight, I usually think its my heart. But after 5 emergency room visits in the past 2.5 years, including a 3 day hospitalization in the cardiac care unit for extensive tests, I was told it was not a heart problem! The doctors told me it was probably related to my GERD problem. I have even had an Upper G.I. series done to confirm the diagnosis, along with a Endoscopic exam in which I was found to have H. Pylori and perscribed the standard antibiotics to cure. After all of this, the chest pains is worse than ever! It is located in the center of my chest, and radiates into my left shoulder, then down the arm. It also can be felt in my back between my shoulder blades, and in the left shoulder blade. It hurts when I move my left shoulder. The pain can also radiate into my right shoulder and arm, my neck, and jaw. I have been experiencing a touch of nausea as of late with no vomiting. The pain can also be felt in the mid section of my stomach, right below the breast bone. I'm not sure if this is related to the chest pains, but I now sometimes get a tingling/burning sensation in my extremities, almost like a numbness.
  Needless to say, it has become very frustrating dealing with my doctors, when the pain is still with me. This medical problem has completely distroyed my quality of life! It has become a full time obsession for me, and I just don't know where to turn for help from here. Even though I had that cardiac work-up 7 months ago, I'm still not convinced its not heart related pain. If anyone out there can give me any advise, it would be greatly appreciated!!!
  Many Thanks
  James  
Dear James,
Chest pain can be secondary to a cardiac, pulmonary, gastrointestinal or  musculoskeletal cause but can sometimes be a manifestation of anxiety or panic disorder. If the chest pains were caused by gastroesophageal reflux alone, I would expect the lansoprazole (Prevacid) to have relieved the pain by now. Other gastrointestinal causes for chest pain include esophageal spasm and other motility disorders. You may need to be tested for these disorders. Various medications (such as nitroglycerin, calcium channel blockers, anti-depressants) have been tried for chest pain secondary to esophageal motility disorders with variable success. If stress is a factor, techniques to reduce stress may help as well. Trying a weight loss and exercise regimen may also help. It may also be helpful to analyze your diet carefully to see if any particular foods (such as coffee and caffeinated beverages) are contributing to your symptoms.
The fact that the pain has been persistent for such a long time may also be an indication that the heart is not responsible for your pain. Nevertheless, the gold standard to rule out a cardiac cause of chest pain is a cardiac catheterization. This is an invasive procedure and might not be necessary in all cases. It is important to have a cardiologist determine whether your pain is cardiac in origin and whether further work-up is indicated at this time.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.
If you would like to be seen at our institution please call 1-800-653-6568 our Referring Physicians' Office and make an appointment to see Dr. Muszkat, one of our experts in Gastroenterology.
HFHSM.D.-ym
*Keywords: chest pain, causes, evaluation, treatment