What Causes Dull Chest Pain?

Posted on Mon, 13 Nov 2017

Question: Have consistent dull ache on the left side of chest that comes and goes. Location is more towards the end of the rib cage / upper abdomen closer to breastbone and on the left side. Already done cardiac workup - including 2- 2D echos, TMT, Holter and multiple cardiology consults that all came back normal except for frequent monomorphic PVCs. Pain comes and goes and is unaffected by exercise. Chest X Ray PA and ultrasound of abdomen are all normal. Please advise as to what other issues can cause this kind of pain.

Answered by Dr. Prof. Kunal Saha (1 hour later)

Brief Answer:
Likely to be due to GERD

Detailed Answer:
Thanks for asking on HealthcareMagic.

I have gone very carefully through your query. Your problem seems to be due to gastritis or gastroesophageal reflux. Our gastrointestinal tract has a forward propulsive movement (peristalsis) that moves the food material forward as it is digested, absorbed and finally expelled as feces. If somehow this movement gets hampered, food along with the digestive juices would stagnate, stomach acid will reflux into the food pipe and on the other hand the bowel habits would not be proper.

In order to relieve yourself, you need to do the following:
* Avoid spicy food. Take small but frequent meals. Avoid long gaps between meals.
* Avoid alcohol intake (if it a part of your habit).
* Take Prilosec (omeprazole) once daily before breakfast.
* Take plenty of green leafy vegetables as well as other sources of dietary fibers. Take fiber supplements like isabgol/psyllium husk or senna. I would insist you to increase your dietary fiber intake.
* Regular morning walk and exercise to keep the bowel movements proper.
* If I had a patient like you I would perhaps have suggested Prodep (fluoxetine) 20 mg tablet (long term anxiolytic and a prescription drug) once daily for at least 2 months (it may take time for the action to set in). Discuss about this with your treating physician.
* Take curd or yogurt on daily basis. It contains beneficial bacteria and should help.
* Stress reduction has a very important role to play. Yoga and meditation should help.

Hopefully that should help.

Let me know if I could help further.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Prof. Kunal Saha (2 hours later)

Thank you Dr. Saha for your comprehensive answer. I however forgot to mention that this discomfort has been persistent for over 4-5 months now. During this time - I was predominantly focusing on it being cardiac in nature and have not explored other options.

I am curious to know if gastritis/GERD can cause this kind of consistent dull ache - not very painful, not a burning - just a dull ache. Also - should'nt gastritis discomfort change when you eat or have an empty stomach? I have observed this pain occurs sometime with meals and sometimes on empty stomach as well. The only thing about this is it is kind of localized to the left side of chest, below left nipple, near the second last rib - closer to breastbone.

Also observed the pain is relieved when lying down and not there in the morning immediately as I wake up. It starts thereafter and comes and goes during the day.

Please advise. Thank you.

Answered by Dr. Prof. Kunal Saha (42 minutes later)

Brief Answer:
Costochondritis is another possibility to consider

Detailed Answer:
Yes, gastritis or GERD is typically responsible for such a presentation. Had the pain been a sharp one, and overlying the end of the rib-cage (cartilagenous portion), I would have indicated the possibility of costochondritis which would be relieved on taking pain medication like Aleve (naproxen). However, that is another probability to consider.

Pain in GERD is not always typical although it may vary with food intake. Try the suggestions and see if it helps.

Regards

Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar