Why am I facing spasms in the middle portion of the chest?

Question

Hi doctor,

I have been smoking for ten years. But I quitted for a year now. I have mild asthma and taking asthma medicine. I am having stomach acid problems for a year and using Pantoprazole for this issue. I have terrible muscle spasms for more than a year. When I have a lot of stomach acid or I am active, my middle portion of the chest gets worse. I have taken ECG four to five times and they have not found anything. But I have also taken ECG even without spasms. I have also taken gastroscopy to check the esophagus. But they found nothing.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query. I am sorry for the discomfort you are having. Do you have any dysphagia that is difficulty in swallowing food?

Spasm in the middle of chest includes following differential diagnosis:

1) Could be related to heart and heart vessels - This has been to rule out with ECG (electrocardiography) done four to five times which came normal. Also, it is unlikely to have CAD (coronary artery disease) at your age unless there are family history and risk factors associated with it.

2) Musculoskeletal symptoms - This would present more like pain in chest muscles, on palpitation and aggravates with specific movements. Obviously, this can also be ruled out as your symptoms are not consistent with it.

3) Related to the esophagus - You mention that there is a spasm in the middle of the chest, which correlates with the anatomical location of the esophagus. However, you have done gastroscopy, which came normal. But if there is some motility disorder of the esophagus, it could present as a muscle spasm in the middle of the chest.

If it is some kind of motility disorder, the following tests can be done:

1) Barium swallow.

2) Esophageal manometry.

So, I have tried to bring a differential diagnosis to rule out the history you have given in the query. I would suggest you visiting a gastroenterologist to address your clinical condition and to find out if there is any motility-related problem or not. I hope you find this helpful. Follow up if necessary. Thanks.

Answer 2

Hi,

Welcome back to icliniq.com.

An esophageal spasm can cause such discomfort, but it cannot be produced on pressing between the chest (as you mention, you get cramps if you press between chest). Also, you do not have any dysphagia episodes, so a motility disorder of the esophagus or esophageal spasm is unlikely according to the medical history which you have given.

"It is almost so I can feel that there is inflammation from the bottom of the throat and down to between the breasts" - I do not know what exactly you mean by saying this. Muscular spasm is possible, but the question is why it would occur? And how it would get aggravated or intense when you are active or a lot of stomach acid is present? Check your serum calcium and vitamin D level. Do you have any symptoms of GERD? Though GERD does not typically cause a muscle spasm, acid reflux in the esophagus can cause cramps that you may feel like a spasm in the middle of the chest.

Do Barium swallow after consulting a gastroenterologist only if the doctor there suggests so. Continue taking Pantoprazole tablet for stomach acid problem because if it is related to reflux of acid, then it will subside. Nerves being pressed, as you said, would cause muscle not to function properly rather than occasional muscle spasm. So, it is unlikely. I have tried to narrow down the possibility but visit a nearby doctor as medical history and physical examination gives more clues to make a possible diagnosis. Follow up if necessary. Thanks.