Gastritis with Chest Pain - Did we miss anything?

[tmulloy]

I am a 34 year old male. 3 months ago I went to the hospital with chest pain.  They admitted me for 3 days and I had a stress test, xrays and MRI on my chest.  My blood was tested and all was clear and I was released.  1 month later I had a similar episode and went back to the hospital, this time they did a cardiac catherization and an ecoscan on my heart and I cleared.  They told me it was in my head(anxanity).  I continued to have the episodes more frequently and returned to the hospital for the 3rd time, this time a endoscopy was performed and I was diagnosed with Gastritis.  Protonix was prescribed, I thought that we had found the cause of my pains.  

The episode continues to get worse.  I start by feeling paplations in my heart area.  I have a sharp pain in the top left part of my left breast.  Its sensive to a light touch. I then taste a metalic taste in the back of my througt.  I feel a hot sensation and then my left are goes numb and then the left side of my head.  Typically getting up and walking around(which Ive done twice writing this letter) helps.  Also cold sweaty palms.  The pain feels like a heart attack.  However my doctor keeps telling me that my heart is fine and not to bring it up again.  

Last Friday I had an episode and I called my doctor.  He told me to come in imeditaly.  When I got there, I was still in my episode(which usually lasts about 30-40 minutes).  My blood pressure was 160/110.  My Colestral is elvated and I am overweight(5'10" - 250lbs(was 290 3 months previous)).  He was concerned with the only left side of my body being numb and the metalic taste in my mouth.  So I went to the hospital for the 4th time.  This time a neurogalist doctor looked at me and performed catscan, MRI on neck/head, Ecoscan on my neck and heart again.  Everything cleared.  No sign of stroke, but they want me to come in to get a EEG as an outpatient.  He put me on Depokate and sent me home telling me he was confused.

Its been 1 week since, I was feeling better then ever since my doctor prescribed Celebrix for the chest pain.   Again I thought I had a solution.  Ive been strict with my diet(bread, rice, tuna(all bland)).  However tonight, it all came back again.  Stronger than ever.  It seems to come when Im in a resting position and not when Im exercising.  I keep pacing all night to advoid it getting worse.  I feel like going to the hospital again, but for what???  My questions are:

1.> Can I 100% rule out the heart, since Ive done the cardic catherization?
2.> I have tons of stress at my job, they are trying to fire me since Ive missed so much work.  I just bought my second house and broke up with my girlfriend after 4 years.  Im trying to elimiate the stress in my life.  Is this the main contributer?
3.> Ive had this episode maybe 20 times in the last 3 months and Ive been fine after 30 minutes every time, should I just ignore them and continue to treat my gastritis?
4.> Do you recommend any other tests?

Thanks, Tom

[Kevin Pho, MD]

Hello - thanks for asking your question.

To answer your questions:

1) You have had quite the workup.  Regarding your heart - you have had the best test we have, the catheterization.  Nothing is 100%, but that is the best test we have and it makes the pain coming from your heart very unlikely.  

2) If all the other tests are negative (i.e. endoscopy, ultrasound, catheterization etc.), then stress can certainly play a role in any chest discomfort.

3) I cannot comment on treatment decisions in this forum.  I would discuss this with your personal physician.

4) I would continue to rule out other GI causes - you have mentioned that your ultrasound was negative.  You may want to consider a 24-hr pH study to see if any GERD is present.  Another consideration would be a HIDA scan with CCK stimulation to make sure that the gall bladder is not causing your discomfort.

If the GI workup is non-revealing, I would evaluate for chostochondritis (incidentally, the most common cause of chest pain).  For further evaluation, a rheumatology or physiatry (rehabilitation specialist) can be consulted for their opinions regarding evaluation and treatment.  

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.

Thanks,
Kevin, M.D.

[surgeon]

have they checked out your gallbladder?

[RoseLady]

Ask your doc about costracondritis/costracardritis.  I don't know if I'm saying it correctly or not but after going through something very similar to you years ago and being convinced that I was having repeated heart attacks, many many tests were run and the conclusion/diagnosis was the above.  I was put on medication which did alleviate my sypmtoms.

[tmulloy]

Sergen,

I had an ultrasound done and they said that my gallbladder was fine.  The other reason the doctors said was because there was no pain on the right side under the rib cage when pushed.  I do have pain on the left under the rib cage.  Its hard for me to distinguish because the chest pain is usually much greater.  My doctory gave me Celabrix last week and it seems to be helping with some of the chest pain, allowing me to feel a different pain directly under the rib cage on my left side.  

Regards,
Tom

[tmulloy]

What medication were you put on that releived the pain?  

I know that I have gastritis.  The endoscopy said so, however I am eating bland, bland food(rice and bread products). Im taking Protonix and Celebrix.  Therefore, why hasnt the chest pain gone away?, I ask myself.  Last Saturday I was climbing a ladder and it caused a servere chest pain.  Also when I am driving(left arm raised) causes the pain, If Im in the passenger seat the pain is less.  But after a meal I get the pain also.  Its confusing to me.  If I move to a different position while sitting I can sometimes help the pain go away.

Did you get pain when doing something physical?  What did you do to releive the pain(heat pack)?

Thanks,
Tom

[Mollan]

Could some of your later symptoms be from the Protonix itself?  
I had some very strange symptoms from taking Prevacid, none of which were listed in the literature. I was taking Prevacid for chest pain. When I worried about it, I got a high blood pressure, numbness and tingling in the arms, and palpitations.
The symptoms from Prevacid were shaking and tremors of the hands and lips, a feeling of anxiety and fear, which all disappeared after stopping the Prevacid.

[Mrs. Boeving]

Aside from your Gastritis, I believe firmly your stress level is a major factor.  For the last couple of years I had heart palpitations,many symptoms, was rushed to emergency. Had all the heart tests, all came back fine. When I began a program to treat anxiety, it was amazing how little by little my heart problems started to abate.  My stressors didn't necessarily disappear but the great salvation was learning skills to cope with the stress and it's had a tremendous change in my body and my mental facilities.  Not drained anymore or keyed-up all the time. In light of the stresses you mentioned, I strongly recommend an anxiety program.  If you do the homework, it does work! Best of luck. D.,

[Tmoore]

I have been having the same symtoms for the last year and a half. Just like yours my episodes will last for about 30min. I have done ekgs, stress tests, ultrasounds, bloodwork,& xrays. Nothing has been conclusive. My doctor put me on paxil, thinking it was stress or anxiety related. There was no difference with the paxil. I  sometimes will go for weeks with no symptoms and at other times have the symptoms for weeks. When I have an episode my blood pressure is elevated just like yours. I have trouble with my left hand being numb as well. I am 36 5'10" 285lbs. I have noticed that when I eat solid foods It will sometimes get worse or even trigger an attack. I sometimes get nauseated just after taking a few bites of food. I would be glad to know what this is - it is real bothersome. By the way, I have the sleep trouble as well!

[chidox]

A related discussion, gastritis and pregnancy was started.