chest pain on exertion

[fredg]

I've had GERD since my early 20's (I'm 46 now).  I've been treated off and on, by various doctors, with Tagamet, Axid, Protonix, Aciphex, and most recently, Nexium.  The most remarkably successful treatment, however, was about 3 years apo when I put myself on a low-carbohydrate diet (almost completely eliminated heartburn.  Also lost 25 lbs. and took my cholesterol down 70 points!).

About 18 months ago, I noticed a severe chest pain while walking my dog.  A stress test was abnormal, and I had an angioplasty to clear a 95% blockage in a right coronary artery.

  I've had cardiac rehab, have normal blood pressure and heart blood supply, and my cardiologist insists that this is NOT angina.

  What I feel is chest pain on exertion.  Feels like a "burning pressure" under my sternum.  If I rest, the pain ceases within 30 seconds, and I can resume exertion without pain!  Feels NOTHING like the heartburn I have grown accustomed to over the past 20+years.  Sometimes a slight burp will relieve it.  This REALLY mystifies me, as I am an "experienced" GERD sufferer, and have NEVER experienced this before.  No shortness of breath, dizziness or fatigue accompanies this.

  To solve the mystery, my GP sent me to a GE to get scoped, which revealed gastritis.  I also have begun having occasional night-time acid aspiration, my GERD has returned, and I think I'm having esophageal spasms as well.  I also have an hiatal hernia.

Anyone else out there with this exertion-induced chest pain, and is it a digestive tract issue?

Fred G.

[flo82]

A related discussion, Upper Right Abdominal Pain upon exertion was started.

[Tomasello_MD]

I am always concerned about chest pain with exertion. While it may be due to gastritis or acid reflux, these are less likely. The fact that a "burp" improves the symptoms does, however, point to a gastrointestinal problem. Interestingly, your diet appears to have helped the symptoms in the past. Possibly other dietary changes need to be explored.
Here are other factors which contribute to GERD
1. Eating large meals
2. Obesity
3. Hiatal Hernia
4. Caffeine
5. Smoking
6. Alcohol
7. Chocolate
8. Fatty or spicy foods
9. Peppermint

Other non-dietary measures which may be helpful include:
1. Elevation of the head of the bed 6 inches.
2. Use of an antacid (Mylanta/Maalox 30ml) after meals and at bedtime.
3. Use of H2 Blockers (Zantac/Tagamet) to reduce gastric acidity
4. Use of agents which increase the ability of the LES (lower esophgeal sphincter) to fully close (Reglan)
5. Use a "newer" agents such as Prilosec, Prevacid and Aciphex which serve to greatly reduce the acid secretion of the stomach and improve the ability of the LES to fully close.

If you have not had a blood test to check for "H.Pylori", I would recommend this as well. This is a bacteria that we all have in our intestinal tracts, but if too much is present, it can contribute to GERD.

If all these measures fail to give you results, it may be time to consider a second cardiology opinion.

[Wilson]

Chest pain on exertion sounds more like a heart or lung thing to me. Mitral valve prolapse comes to mind, but I would think they'd have seen that by now.

[Suziepie]

The only thing my daughter has experienced is gastritis, but she has parasites.  You didn't mention anything about poor bowel movements ,gastroparesis, or loss of weight, so it must be something else.

[fredg]

I guess I should clarify the above a little bit.

After the angioplasty, the chest pain remained unchanged.  It has maybe gotten a little better, since I started exercising.

The esophageal spasms are only suspected on my part; there has been no diagnosis.

I'm wondering if it is common for exertion-driven chest pain to be digestive in nature, rather than cardiac, and if anyone else has/is experiencing this.

Thanks,

Fred G.