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How Should Intermittent Burning Sensation In The Chest Especially After A Heavy Metal In An Obese Person Be Treated?
Question: hi Iam 30 year old male obese Iam facing chest burning for almost close to 2 years. visited multiple cardio specialist all tests came back normal ECG,treadmill test,echo,chest x-ray.blood reports were normal with mild rise in cholesterol levels using rozat 5mg for that.all the doctors think it's not cardiac related.mostly acid reflux but my symptoms are atypical to gerd like I get chest burning sensation while walking not while lying down but then again on days I get burning sensation even when lying down continously for hours antacids doesn't help much.after changing my medicine to Sampraz d40,nebicard 2.5mg,rozat 5mg.burning only occurs after heavy meal especially if I walk or climb stairs immediately after a meal.lying down relieveds pain there is another kind of chest pain it occurs when walking it's mild not burning first it occurred on left side now it's coming on right side it happens only when walking after 5mins no problem when climbing stairs.had endoscopy year back to check my stomach it was clean.
Brief Answer:
Can be cardiac.
Detailed Answer:
Hello,
I am a Gastroenterologist and would help you to sort out your problem.
Firstly keep aside all investigations, the characteristic feature of pain related to acid peptic disorder is that it responds very well to antacids and proton pump inhibitors.
Secondly, your endoscopy was already clear as mentioned.
Thirdly as per you after heavy meals on exerting you feel pain.
I have gone through the names of investigation you have gone through for cardiac check-up.
Unfortunately, all these tests combined together in this era has a sensitivity less than 70%. This means that even if echo and stress tests are normal in 30 out of 100 patients having cardiac disease.
Your cardiologist should have done either Stress M1B1 gated stress thallium test(99%) sensitivity and noninvasive or an angiogram gold standard 100% sensitive.
See when a patient presents with your symptoms as per textbook there are 4 differentials-
1) Rule out cardiac-Having burning not responding to antacid. Postprandial angina(after heavy meals) and just because some old school tests are negative you are cleared. Not my cup of tea sir.
2) Gastric-99% times respond to antacids etc.
3)Anxiety-You have not mentioned about them.
4)Muscular-Not your case.
Are you a smoker? I'd strongly recommend you to go for STRESS THALLIUM test, 99% sensitive.
The only problem is at an age of 30, cardiac origins of the problem is rare but still, we can see 2 out of 100 cases below 30 in I.C.U having cardiac complications.
Please feel free to write back.
I would be happy to help further.
Can be cardiac.
Detailed Answer:
Hello,
I am a Gastroenterologist and would help you to sort out your problem.
Firstly keep aside all investigations, the characteristic feature of pain related to acid peptic disorder is that it responds very well to antacids and proton pump inhibitors.
Secondly, your endoscopy was already clear as mentioned.
Thirdly as per you after heavy meals on exerting you feel pain.
I have gone through the names of investigation you have gone through for cardiac check-up.
Unfortunately, all these tests combined together in this era has a sensitivity less than 70%. This means that even if echo and stress tests are normal in 30 out of 100 patients having cardiac disease.
Your cardiologist should have done either Stress M1B1 gated stress thallium test(99%) sensitivity and noninvasive or an angiogram gold standard 100% sensitive.
See when a patient presents with your symptoms as per textbook there are 4 differentials-
1) Rule out cardiac-Having burning not responding to antacid. Postprandial angina(after heavy meals) and just because some old school tests are negative you are cleared. Not my cup of tea sir.
2) Gastric-99% times respond to antacids etc.
3)Anxiety-You have not mentioned about them.
4)Muscular-Not your case.
Are you a smoker? I'd strongly recommend you to go for STRESS THALLIUM test, 99% sensitive.
The only problem is at an age of 30, cardiac origins of the problem is rare but still, we can see 2 out of 100 cases below 30 in I.C.U having cardiac complications.
Please feel free to write back.
I would be happy to help further.
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
I don't smoke nor consume alchoal. I had my doubt about angina only issue is my pain even when lying down shouldn't it be unstable angina close to two years.shouldn't there be changes in ecg every time I get a ECG it's normal my tmt were always negative for cornory artery dieaase all the cardiac doctors said it's either acid or mental issue
Brief Answer:
You can understand that you are not a text book case so investigation and eliminating the possible causes is the only way we have.
Detailed Answer:
Hello again my dear patient,
Classical changes or features of angina are hardly seen in 30% of cases.
Secondly unstable angina never presents as changes with ECG To differenciate between unstable angina and M.I only blood levels of cardiac troponins are done.
As explained by me earlier if it would have been gastric then this thing would have responded to the antacids you were on secondly endoscopy would have reflected something.
The only possibility left is Anxiety issue.
Its very easy go to a pyschaitrist and get anti anxiety medications for 2 weeks.In case pain does not responds to it then go for stress thallium.
ECG as explained earlier is a overhyped test.Useful only in few cases.
Its one of the most overrated tests of medical science.
There are some very rare causes too like esophageal spasm etc,But we can move to them once we are sure that you are not one having the common cause.
I have seen a number of cases during my career who present with cardiac ailment and less then 30 years of age,TMT as i said has very low sensitivity.If you are having constant problem stress thallium with gated has to be done. When we have technology then there is no use of making wild guesses.
Thank you.
You can understand that you are not a text book case so investigation and eliminating the possible causes is the only way we have.
Detailed Answer:
Hello again my dear patient,
Classical changes or features of angina are hardly seen in 30% of cases.
Secondly unstable angina never presents as changes with ECG To differenciate between unstable angina and M.I only blood levels of cardiac troponins are done.
As explained by me earlier if it would have been gastric then this thing would have responded to the antacids you were on secondly endoscopy would have reflected something.
The only possibility left is Anxiety issue.
Its very easy go to a pyschaitrist and get anti anxiety medications for 2 weeks.In case pain does not responds to it then go for stress thallium.
ECG as explained earlier is a overhyped test.Useful only in few cases.
Its one of the most overrated tests of medical science.
There are some very rare causes too like esophageal spasm etc,But we can move to them once we are sure that you are not one having the common cause.
I have seen a number of cases during my career who present with cardiac ailment and less then 30 years of age,TMT as i said has very low sensitivity.If you are having constant problem stress thallium with gated has to be done. When we have technology then there is no use of making wild guesses.
Thank you.
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Above answer was peer-reviewed by :
Dr. Nagamani Ng
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