crushing chest pains

    
      Re: Re: Re: crushing chest pains
    


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Posted by HFHSM.D.-rf on March 08, 1998 at 21:56:07:

In Reply to: Re: Re: crushing chest pains posted by Kathy on March 05, 1998 at 16:44:43:

: My husband is also experiencing severe chest pain (age 40).  He has had an
  endoscopy and is currently taking Prilosec.  He has taken Propulsid in the
  past.  Should he resume the Propulsid in combination with the Prilosec?  
  The Priolosec alone does not seem to be giving him any relief this time
  around.  Could the chest pains be caused by him developing a hiatal hernia
  since the endoscopy (done this past summer).  Also if an esophagheal spasm
  is detected
(should he have the test), what would be the suggested
  treatment?
______________________________
Dear Kathy,
There are a number of causes for chest pain.  Before undergoing an evaluation of possible esophageal causes, it is first necssary to exclude cardiac (heart) causes.  You do not provide any details regarding your husband's pain.  Your husband should see his physician who can obtain an appropriate history and perform a physical examination.  Often a cardiac cause can be excluded by this approach.  Sometimes, however, it is necessary to perform a cardiac stress test to exclude a cardia cause for the pain.
If your husband has an esophageal cause for his pain, there are several conditions to consider.  Esophageal reflux (acid entering the esophagus from the stomach) is the most common cause for esophageal-inducd chest pain.  Usually, esophageal reflux is improved by treatment with Prolosec.  Failure to alleviate his symptoms raises the possibility of other conditions.  Was your husband's EGD normal?  If it was, we can exclude the possibility of Barrett's esophagus.  If the EGD was normal, we must consider an esophgeal motility problem as a potential cause for his chst pain.  To evalutae this possibility your husband will require an esophageal motility study.  At the same time, he should probably have a 24 hour pH probe study to definitively answer any questions regarding possible esophageal reflux.  I would not initiate treatment with Propulsid until there is a better understanding of the cause for your husband's chestpain.
A hiatus hernia is a relatively common finding and is usally nt th cause of chest pain unless there is concurrent esophageal reflux.  I would not attribute his pain to the recent develpment of a hiatal hernia.
This information is provided for informatioal purposes only and should not be considered a formal evaluation.  If you have specific questions, please contact your physician.
If you are in the Detroit area and wish to be seen by us, please call the Division of Gstroenterology at [phone] and requet an appointment with Dr. Zonca, one of our experts in the evaluation of noncardiac chest pain.
Best of luck.
HFHSM.D.-rf
keywords:chest pain, esophageal reflux, esophageal spasm
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