pain during running

[tubbs]

I am a 44 yr old male in good health, with a normal body weight, and a diagnosis of GERD.  I have no risk factors for CAD other than high cholesterol which is managed with Mevacor and Cholestid.  My problem is that I experience a strange pain in my upper chest and throat with exercise. If I sprint, jog, play tennis, or basketball, I will get this pain.  It is fairly intense and it makes me very lightheaded. I must stop immediately and within less than a minute the pain goes away. Biking at very high intesity does not produce this pain. Because of the strangeness of this condition I actually had an exercise stress test about 18 mos ago which was negative.  My EKGs are also normal.  Because an upper GI showed that I had widening of the lower esophagus combined with frequent episodes of heartburn, I was placed on Prilosec.  I took this for a year and while it did help the other causes of heartburn I would experience, it did nothing to eliminate the pain during exercise.  Eventually, I came off the Prilose, since the main reason I was taking it was the hope that I would be able to exercise normally again.  I now control infrequent episodes of heartburn with dietary and lifestyle modifications and am not too troubled by it. I know exactly what foods and drinks to avoid and also do not eat close to bedtime. I am VERY bothered by the pain I get when I try to exercise, however.  My question is this:  have you ever heard of anything like this before and where do I go from here?  Should I consider seeing a GI specialist and if so, is an endoscopy warranted?  Is this possibly some type of esophageal spasm I am experiencing?  Could it be reflux? I have even tried taking an OTC H2 blocker prior to exercise and even this does not help.  I would really like to get to the bottom of this and be able to resume the activities I enjoy doing which right now are out of the question because this discomfort is so limiting. Any light you can shed on this would be appreciated.

[Kevin Pho, MD]

I would agree with Erin, PA's suggestions.  A 24-hr pH study (often in combination with an esophgeal motility) study would shed more light as to how severe the reflux is.  If medication is not controlling the symptoms, then possible surgery should be considered.

The upper endoscopy would always be a more comprehensive evaluation than the upper GI series.  It can also look for ulcers as well as inflammation of the esophagus or stomach which may be causing your symptoms.  I would certainly suggest a GI referral to evaluate your symptoms, especially since the exercise stress test was negative.

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.

[GI.PA]

Dr. Kevin will give you a full response, but a 24 pH probe which monitors acid levels in your esophagus may be helpful.  While you have the probe in, you can exercise with effort to get the symtoms to occur.  They can then look to see if this was correlated with acid reflux.  

A trial of high dose prilosec (or a simular drug such as Nexium 80mg twice daily) X 2 weeks is almost as good as the above test.  If your exercise symtoms improve on this regimen, acid is likely the cause.  If not any improvement, acid is unlikely the cause.  

An esophogeal motility study with provocation may be helpful in looking for esophogeal spasm.  

A good GI in your corner may be a good idea.  

GI.PA

[jhashton]

I also get a pain during excercise, but it is lower (a couple of inches below the breast bone.  The pain starts as pressure, but if I continue it will develop into a pain and also cause lightheadedness.  Stopping the exercise relieves the pain and pressure quickly.  As the pressure subsides, I normally burp which will make the pain go away.

Although strenous biking can cause it, running and tennis are the worst for me.

As you, no acid reducer seems to affect it.

[baileyjt]

I have exactly what you described and it has frustrated me to no end as I am in the military and have to run.  I was prescribed Prevacid by my doctor but it does not help.  I recently took a nuclear stress test to rule out a cardio problem and am awaiting the results.  Today, I went for a run and had to stop several times.  The pain is debilitating.  I also feel it in my left arm.  It truly feels like I am having a heart attack.  I too am 43 and growing quite tired of this problem.  I will probably have to medically retire from service.  If you follow through with the recommended PH testing, please post your results and I will do the same.

[Sue122]

A related discussion, Feel like fainting when walking or talking was started.