Dr. Sagar Ramesh Makode
Cardiology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I have been using Adderall for about three years now. About one year ago, I started experiencing chest pains that would quickly go away after awhile. Then, there were a few occasions where I abused my medication and took too much. Since the last time that this happened (about six months ago), I have experienced squeezing chest pains that last longer and longer. I also cannot drink alcohol anymore because my chest hurts so bad afterward. Now, for the past three weeks, I have experienced a constant squeezing pain in my chest and it does not go away. I have had an echo, multiple EKG, stress test, and a CTA scan of my chest, but the pains are still getting worse. What should I do?
Hello,
Welcome to icliniq.com.
Likely, this is gastritis and reflux disease. Pain occurs due to acid reflux and esophageal spasm. You should avoid fatty, oily and spicy diet. Have some walk after having food instead of taking rest. Have multiple small meals instead of heavy meals. Have regular sleep habits and avoid stress. Avoid smoking and alcohol for few days, for about 2 to 3 weeks. Elevate head end of the bed or use pillows while sleeping. You should get prescribed tablet Pan DSR (Pantoprazole, Domperidone) 40 mg or Esomeprazole, Domperidone combination before breakfast once a day for two weeks, and if relief then two additional weeks. If not adequately relieved, then you should add syrup Sucral O (Oxetacaine, Sucralfate) or Gelusil two teaspoons three times a day for a week.
Patient's Query
Hello doctor,
I have already been to gastro doctor that turned me away. After endoscopy, my gastritis was treated and I completed my medicines several days ago. This squeezing pain is spreading and affecting my breathing. Can coronary spasms be ruled out? These chest pains started after Amphetamine abuse.
Hello,
Welcome back to icliniq.com.
Yes, we always keep the possibility of cardiac ischemia in such scenarios. But, since you mentioned, you have constant squeezing for three weeks which is less likely with cardiac ischemia. Also, you said alcohol made it worse, which again favors gastritis and reflux as alcohol strongly induces acid production and it also irritates the mucosa. Did you have ECG anytime during chest pain? If yes, it should have shown some changes during ongoing pain. However, if not, then you should have ECG (electrocardiogram) during pain or may undergo Holter monitoring when the pain is intermittent. So from the point you mentioned, gastroesophageal reflux becomes the likely possibility. Next thing, was there relief with gastritis treatment? Next, do you smoke a lot? This can cause damage to lungs and lungs lining which can cause a lot of pain in bilateral chest especially of a pleuritic type like sharp pains increasing on inspiration. So overall, I think, you should once more have a trial of antacids like PPI (proton pump inhibitors) and local anesthetic gel-like Mucaine gel and see for relief.
Patient's Query
Hello doctor,
So all of the tests that I have run can definitely rule out a life-threatening issue?
Hello,
Welcome back to icliniq.com.
Likely, they will rule out life-threatening issues. However, you should gradually decrease its abuse. Because, high level of drug at any time may predispose one to acute cardiac issues, arrhythmias, etc. So, avoid abuse.
Patient's Query
Hello doctor,
I have not abused it in several months. But this pain is there.
Hello,
Welcome back to icliniq.com.
Yes, then it is unlikely to be cardiac. Because, it will cause coronary spasm and all, till it stays in the system. The effect will not be permanent and even if it is then it should have been shown the tests you have undergone. So not related to the heart.
Patient's Query
Hello doctor,
Would any type of anxiety medication help ease my chest pain? The gastro doctor told me it was likely stress.
Hello,
Welcome back to icliniq.com.
Yes, you should have tablet Etizola beta (Etizolam and Propranolol) 0.5/20 mg bedtime for anxiety.
Patient's Query
Hello doctor,
So what should I do if pain persists after all of this?
Hello,
Welcome back to icliniq.com.
If pain persists then you should have a trial of NSAIDs for a period of a week like Naproxen 250 mg two times a day. This can worsen gastritis and reflux disease, that is why I want to make sure that we are not dealing with it. Also, we may subject you to chest X-ray and CT (computed tomography) scan, if needed. Does this pain increase after meals, lying down, night? Does this pain increase on applying pressure over the chest or is it deep inside?
Patient's Query
Hello doctor,
I just got the results of my CT scan back. I have a hairline fracture in my back. That does not explain the chest pain after a night of drinking though does it?
Hello,
Welcome back to icliniq.com.
Yes, it can, especially if involving spine and there is a possibility of nerve compression. What kind of pain do you get? Is there a burning, tingling, numbness, kind of band type constricting your chest? Was there a trauma? Because, if there was trauma after drinking causing hairline fracture, then it can nerve compression and lead to neuropathic kind of chest pain. So in such needs nerve stabilizer like Pregabalin.
Patient's Query
Hello doctor,
Yes, it feels like a tingling burning sensation that radiates across my chest and makes it hard to breathe. I also feel an intense squeezing on the left side of my chest.
Hello,
Welcome back to icliniq.com.
Is there anything mentioned in CT regarding vertebrae, disc space, etc. So you should get prescribed on tablet Pregabalin 75 mg bedtime and increase to two times a day if tolerated. You should also take tablet Neurobion Forte once a day which is a nerve vitamin. Should seek orthopedics opinion once.
Patient's Query
Hello doctor,
I will have more information on the fracture tomorrow. So, I will be sure to let you know.
Hello,
Welcome back to icliniq.com.
Okay. Take care.
Patient's Query
Hello doctor,
I found out that I had a mild concussion after the fall and my fracture is in the middle of my back. These chest problems have been getting worse and worse since the fall. But they are especially bad after a night of drinking
Hello,
Welcome back to icliniq.com.
Do you have your CT scan report? It is likely a neuropathic pain only due to nerve compression. Compression pain is band like pain, associated with burning, tingling, numbness etc. So you should have nerve stabilizer like Pregabalin and nerve vitamin like Neurobion forte.
Patient's Query
Hello doctor,
After several months, I am still experiencing a squeezing, burning chest pain in my upper left chest. It hurts the worst when I am exercising hard and right as I am about to fall asleep. I have been scoped by a GI doctor and treated for gastritis, I have been cleared by a spinal doctor for a compression fraction and annular tears in my thoracic spine, and I have received multiple EKG's, a stress test, a chest x-ray, an echo test, and a CT scan by a heart doctor. This all started last fall. I drank excessive amounts of alcohol after snorting adderall one night in November, and then I went to the hospital the next night due to chest pain. This was not the first time that I did this that semester. Since then, the pain has only gotten worse and more persistent. All I have been prescribed is buspirone for moderate anxiety; this helps but I do not think anxiety is the problem. Should I be seeking another opinion from another doctor? Can all heart problems be ruled out from the tests that have been done without a reasonable doubt? Also, I have been told by several people that they have heard me waking up gasping for air. Could sleep apnea be causing this chest pain? What type of doctor would I see to check into this? Symptoms include: burning chest pain, pain like a knot in heart area, palpitations, extreme anxiety associated with pain, trouble breathing (although I have asthma), fatigue, light-headedness, nausea, trouble exerting very much energy, chest pain when singing or shouting for long periods of time, etc.
Hello,
Welcome back to icliniq.com.
It is unlikely to be cardiac pain as presentation is not typical of cardiac pain and also the tests you underwent are reliable. So it does not seem to be cardiac. Also, sleep apnea does not cause such chest pain. Anyway, you may get yourself evaluated by pulmonologist or sleep medicine specialist, whosoever is available, due to other symptoms like gasping. You may discuss the issue of chest pain with him as well. Otherwise, you may take a second opinion from internal medicine doctor so that he will review your records and history to see if something is missed or any clue to diagnosis. Likely the possibility is of musculoskeletal pain other than anxiety. A trial of NSAID like Naproxen for a week can be taken if not had may be beneficial. I guess, the possibility of nerve compression is reliably and it has to be ruled out by the doctor. So, get once reviewed and examined by local internist so as to get some new ideas about possibilities.
I hope this has helped you. Thank you.
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