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Q. I have been having chest pain and palpitations. Can it be coronary artery disease?

Answered by
Dr. Sagar Ramesh Makode
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Jun 13, 2018

Hello doctor,

I weigh 197 but was 224 three months ago. I am 5'8" and have no history of heart disease in my family. My blood pressure is a little high and my cholesterol is normal. My LDL was 120 three months ago before I started losing weight. I have been having chest pain for three months now along with palpitations. The palpitations seem to get worse a day after I do any exercise. In the three months, I have gone running once and when I ran that time the chest pain increased and felt like an ache on the left side of my chest. I have had 6 kg numerous blood work, an echocardiogram, a stress test, and a stress echo test that all came back normal and I did not feel any chest pain during the stress and stress echo. The chest pain seems to come after I have walked a while or when I am stressed even though I have not felt the pain much since I got my result for my stress echo I would say because I have been calmer and also when I wake up some morning I can feel the ache right below my chest. The situation has completely taken over my life as I worry day and night. What are the chances of it being coronary artery disease?

#

Hello,

Welcome to icliniq.com.

It is unlikely to be a coronary artery disease. Firstly, considering your age, it is very unlikely. Next thing, your stress test is normal and you did not have any pain during a stress test. Pain should be uniform of cardiac blockages, and you should have got it while testing as well. So the first possibility in you is gastroesophageal reflux disease, which can explain all your symptoms. You also have epigastric pain, right. Do you also have nausea, vomiting, bloating, burping, throat or chart-burning, these may be the associated symptoms. So you should have a trial of antacids like Pantoprazole or Lansoprazole.

Does this pain increase on applying pressure over the chest area, if yes then it is likely a musculoskeletal pain and unlikely to be heart-related? Also, if your pain is persistent even after antacids as well, I would also like rule out a myocardial bridge in you which can cause exertional pain. However, we would expect some changes on the stress test. Did you undergo you treadmill test or just stress echo? So just go through it and let me know some more details.

For more information consult an internal medicine physician online --> https://www.icliniq.com/ask-a-doctor-online/internal-medicine-physician

Thank you doctor,

I got a stress test first and a couple weeks later a stress echo where I ran till I reached peak heart rate and had an echo done after to compare wall motion from before and after. No, I am not having any symptoms like nausea, burping or the other ones you mentioned and no the pain does not increase when I apply pressure.

#

Hi,

Welcome back to icliniq.com.

I think a trial of antacids should be given for a week. You mentioned about ache below the ribs, which can very well be gastritis. You should avoid fatty, oily and spicy diet. Have some walk after having food instead of taking rest. I guess you do not smoke. Avoid alcohol if any. You should get prescribed tablet Pan DSR 40 mg (Pantoprazole and Domperidone) or Esomeprazole Domperidone combination before breakfast once a day for a week. So overall, the possibility of cardiac illness is very remote. However, if this exertional chest pain continues in the future, we should consider for chest CT scan or MRI in order to look for a myocardial bridge and rule out other pathologies.

For more information consult an internal medicine physician online --> https://www.icliniq.com/ask-a-doctor-online/internal-medicine-physician


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