chest pains, gas, sweats and nausea

[soccermom1321]

About 1 month ago I began having tightness in the center of my chest that was not accompanied by any other symptom. I went to see my doctor who immediately did an EKG and blood work up...all came back normal, including cholesterol. My blood pressure was elevated 140/100 which is very high for me. I am about 100 pounds over weight so I had reason to worry it was heart related. He sent me home with no explanation and no further testing.  He stated if the pain persisted to call and they would schedule a stress test.  The pain continued over the weekend but this time was accompanied by burping.  I called the nurse to say the pains were still there but I was now burping and had a lump in my throat.  She said she had thought it was reflux and wondered why the doc didn't discuss that with me.  She spoke to the doctor and he decided I should start on 150mg ranitidine BID.  Well that worked for all of a week, then the pains came back. This time accompanied by sweats and sometimes nausea.  And not to mention panic and a ton of anxiety on my part.  I did notice that while at our summer home I did have it more after eating certain fatty foods such as mayo or hotdogs. And I had to have several bowel movements during the episodes. Now I just seem to have the pain all the time.  It appears to come within a 1/2 hour of eating, which would make me agree with the doctor's diagnosis.  I am unable to eat anything without having the pains. Every once in a while I do get pain in my left arm but it is always on the outside of the arm or on the back...never on the inside.


Over the past couple of days it has all gotten much worse.  My pains last all day, I have loose stools, a lump in my throat, gas, severe sweats, nausea and occasionally it feels a little harder to breath. I am not winded as I am exercising, but almost the same feeling I get when my asthma starts to kick in.  I don't breathe any faster or heavier but feel the need every once in a while to take a bigger breath to better fill my lungs. Sometimes I think the breathing is due to me stressing out over all this. Today I was walking around Walmart when suddenly my chest became uncomfortable, I began breaking out in a huge sweat and nauseaus. I also experienced the breathing I described earlier. Seemed to be classic heart problems. I am so worried that it is my heart but my doctor nor my nurse seem to listen to my concerns.  They keep saying they are sure it is GERD even though they did not run any tests for it.  Should I seek a second opinion or does it sound like my doctor is on the right path?

[Kevin Pho, MD]

I would certainly seek another opinion.  If the symptoms continue, more testing is needed.  Other causes can include an ulcer, inflammation of the upper GI tract, and of course, GERD that is inadequately trated.  

An upper GI series or upper endoscopy (the latter being the more comprehensive test) would be next to consider.  I would also discuss whether going on a PPI (i.e. Prilosec or Protonix) would be an appropriate step for your case.  

If all the tests are negative, an ultrasound can be considered to evaluate the gallbladder, or a 24-hr pH study to conclusively evaluate for GERD.  

With obesity and high blood pressure, there is certainly increased risk for heart disease.  A stress test to evaluate for heart disease would not be unreasonable.

I would discuss these options 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

[yoshi]

have you tried taking medication which will neutralise the gas in your body such as extra strength gas-x,alka selzer etc??
I have similar problems at first i thought i have a heart problem and i went to see a cardiologist,now i know i have acid reflux.
You need to see a gastro doc.

[soccermom1321]

yes, yesterday I tried phazyme with no help at all.  The pains continued throughout the day.  

As for the gastro doc, I can only do that with a referral from my primary physician who thinks this is nothing but simple reflux that will be cured with the Protonix I am now taking.

It is just very frustrating for me because no matter what I eat the pains come.  This morning I had two pieces of wheat bread and some applesauce and as I type this I feel the pains coming back.  Yesterday I had a bagel for breakfast with a slice of cheese and it was worse than ever.  Last night my family had pizza and I thought, what the heck, I have pain no matter what and I had 2 pieces.  The funny thing is that the pains that came after eating pizza were less than when I had the bagel.  


I am more and more convinced that it is gastro related and not my heart because it happens after every meal.  However the severe sweats and nausea I had yesterday coupled with the pains while walking around Walmart scared the heck out of me. But I now remember popping a piece of peppermint gum in my mouth as I headed to the store and wonder if that increased the pains.  I have read to avoid peppermint and spearmint but didn't think of it when I put the gum in my mouth. Those are the symptoms my doc initially told me to watch out for.  So when I called the doctors office and spoke to the nurse about it, she seemed very disinterested and asked if I had any headaches or vision problems with it.  And since I didn't it wasn't heart related.  Not sure where she got her nursing degree from...I have a feeling she bought it online somewhere. And my doctor is losing his credibility more and more every day. I should have gotten a new doctor the minute I told him about the excrutiating pain I have in my right shoulder when I move certain ways and all he did was say, "Hmmmm" and went on to the next subject.  He never did address it or tell what I can do about it.  I guess I will just go around with my arm at my side at all times and never move it...that is only way to stop the muscle pain I feel. What a bozo!

[yoshi]

yeah,peppermint,caffeine,chocolate,cheese,cream,nuts,fried food,grease,you name it,will trigger problem.
oh,spicy food also and soda drinks

[mmfd]

HI, just a quick note.  Most of the time, in doctor's offices, you are speaking to a medical assistant, not an RN, when you call and ask to speak to the *nurse*.  Some are very very good, and some aren't.  They have very little training and certainly can't diagnose.  MA's are a lot cheaper than RN's!  Some doctors have nurse practitioners who can handle the tough questions excellently, as they are advanced practice nurses.

[transcription lady]

Has your doctor done any tests on your gallbladder? Your symptoms sound exactly like the symptoms I was having four about 3 months. At first my doc also diagnosed me with reflux and after taking Protonix for one month and having no trouble and sticking with a reflux diet my symptoms returned. They did a gallbladder ultrasound and found no gallstones but then did a HIDA scan and found that my gallbladder wasn't emptying correctly. I had a cholecystectomy on Friday and I am already feeling markedly better.

[soccermom1321]

The doctor doesn't want to do any tests and doesn't feel they are necessary.  We will see how I do on the Protonix.  When the pains began my mom said they sounded just like the ones she had when she had gallbladder problems. Not that I could have inherited gallbladder problems from her because I was adopted, but she thought I should have my gallbladder checked as well.  I will probably be looking for a new doctor this week, since I am not very confident in the one I have.

Someone earlier had mentioned that most nurses at doctors offices are just MA's, but that is not the case with my physician...they are all RN's most with a BSN.  But are as dumb as he is.  I went through 4 yrs of nursing school and although I am no longer in that field I know a heck of a lot more than they do!!

[Biskie2]

Have you thought about or been tested sprue celiac disease?

[tessa0825]

Your heart has not been significantly ruled out as being a cause of some of your symptoms. An EKG is not that good of a test. It would tell if you were having a heart attacke at the moment but really useless for anything else. I would definitely ask to have further testing on it. If it were me I would take up his offer for a stress test. Maybe you could also wear an event monitor for a time also.

You could ask for a 24 hr ph test to confirm if you are having reflux. It documents the number of reflux events and the length of time each one lasts during that 24 hr. period..If you have reflux you should stay away from fried foods, mints, citrus fruits, tomato products, etc..Basically, if you eat something and it bothers you then leave it alone.Raising the head of the bed 6-8 inches helps keep acid in the stomach where it belongs instead of it refluxing up into your esophagus during sleep..Losing weight is good for your heart,GERD and your BP. A long time ago when I needed to lose weight, I failed at many different diets. Weight watchers is what worked for me and I was not ever hungry on that diet..Back then you had to eat tuna 5 times a week and liver once a week. That was the only part I had trouble with, but, over the years they have made many improvements and that is not required anymore. Their diet just keep getting better. They really teach you a healthier way to eat.

Do you take meds for your high Blood pressure? 100 on your diastolic is way to high..If your Dr. won't take your smptoms serious, I would be thinking about a different Dr.

I hope you feel better soon and get some answers to help you.

Tessa

[soccermom1321]

Thanks for all your suggestions.  I think I will just get a new doctor first thing next week and hope that I get someone who is much more thorough.  The doctor I have now no longer wants to send me to the cardiologist for the stress test.  He actually said to me on my first that since I am having regular menstrual cycles the estrogen my body produces will protect my heart.  He isn't very old but he is stuck in the dark ages with medicine. He was concerned with my blood pressure but said if I lose weight it will lower my BP and didn't think I needed meds for it...just diet and exercise, which I know is very important.  

Is it possible to break out into severe sweats when having GERD?  It happened again today at Walmart with my children.  I was just walking along when all of a sudden I started having the sweats badly and the some chest pain.  This chest pain was not localized to the sternum area as it usually is but all across my upper chest.  I felt a little tingle in my shoulder blade area as well.  But no other symptoms. And I seem to be starting my period a week early for some odd reason.

[yoshi]

no,GERD would not make a person break out in a sweat.

[Biskie2]

Sometimes anxiety will make a person feel like they are having a heart attack, blood pressure feels up, and will break out in sweats and will panic. An anti-anxiety medication will help that, like Xanax, etc. You may also want to have a celiac test too, as it seems this happens after you eat breads, starches, etc.

[hollyd28]

I would have to agree with transcription lady.  Have them check your gallbladder.  Reflux usually happens when you haven't eaten, and eating will make it better.  But, with gallbladder problems, eating will make it worse.  I also had an ultrasound that showed no stones, but had a HIDA scan and my gallbladder was only working at 20%.  Haven't had the surgery yet, trying alternative treatments for now.  But, it may be worth looking into.

[soccermom1321]

Just an update:
I ended up in the ER last night due to the pains (which were actually pretty minor) but suddenly I had numbness in my arms and in my face.  That coupled with the perfuse sweating I experienced while walking around Walmart scared the **** out of me.  They did 2 ekgs....one during the pain and one after the pain.  They also did enzyme test and chest x-ray.  All came back normal.  The doctor said I didn't really have any significant risk factors of heart disease, although she did not mention my weight...hmmmm.  Anyway, she thought it was probably gerd and said numbness ocassionally happens and the sweats are just a body's reaction to stress at times.  She gave me this numbing cocktail that when swallowed caused my mouth, tongue, throat etc to go numb.  This was to rule out gastric problems, however the pain continued but was very minor.  As the medicine wore off the pain became greater.  The doc checked all my EKG again and said it was still normal.  Then she prescribed IV Protoxin.  Was told the pain would be relieved in 5-10 minutes...didn't happen.  Pain increased actually.  12 hours later I still have the pain.

After finding nothing conclusive they sent me home.  She diagnosed me with atypical chest pain and GERD.  I am to keep an eye on things and let my doctor know if things get worse.  Then they gave me a sheet to tell me when I needed to rush to the ER...I had to laugh because I have been experiencing most of the symptoms, so actually I should be going to the ER all the time...lol!  

I will be contacting a new doctor on Monday and will ask for a referral to a Gastro doc.  The ER doc did also mention. gallbladder and said to look for pain on the lower right side. I will ask my new doctor about the possibility of that.  Makes sense to me since the IV Protoxin did nothing to help the pain.

Hey does the doctor actually respond to these messages?  Just wondering since I posted this days ago and he has yet to respond.

[tessa0825]

Most Gallbladder pain is in the upper right quadrant. Usually just a little over from the sternum area and right under the breast.. I have terrible GERD with Barrett's esophagus and dysplasia and it is possible to have esophageal spasms that will make you think you are having a heart attacke and yes they have taken my breathe away, doubled me over, and made me break out in a sweat..Manometry is a good test to document esophageal spasms. I use a cocktail of bentyl, 2% lidocaine and mylanta. A problem with a GI cocktail is it has been my experience that during one I can't possibly swallow so I have to wait for it to pass to even drink the thing..Not much help by that time..Going to see a GI spec. is a good start..

[soccermom1321]

They gave me that little cocktail at the ER. Other than numbing my tongue, lips and throat it didn't numb the pain.  I am assuming that is what it was supposed to do.  The pain was definitely less severe though. Not sure if it was one of the times it had subsided or not.  As soon as my mouth numbness wore off the pain came back...could still be an indicator that it was GERD.  Just wish I could have a text book case so I wouldn't have to worry so darn much.  It has been over 24 hours now since the pain started yesterday and I still have it...it never went away even with the intravenous Protonix I was given.