[20F] Experiencing vomiting, difficulty breathing, and chest pain

Patient Description

A 20-year-old female presents with a history of vomiting, difficulty breathing with a pinching pain in the back right shoulder blade, weight loss, fatigue, lightheadedness, and chest pain. The vomiting occurs in the morning and during meals, often consisting of yellow bile or undigested food, and is triggered by heavy sauces. The difficulty breathing has been ongoing for 8 months and is rated 8 out of 10 in severity on good days. The patient finds some relief by standing up straight, stretching, and chewing mint gum. The lightheadedness is described as faintness, especially when breathing issues worsen. The patient also reports a pain in the ribs when breathing and violent shaking associated with the pain. A few weeks ago, the patient coughed up blood but has not since then. The patient has experienced sharp chest pain that radiates, suggesting a possible cardiac issue. There is no known family history of cardiac or gastrointestinal diseases, no known allergies or adverse reactions to medications, and the patient is not currently on any medications. The patient has used tobacco, alcohol, or recreational drugs recently and has no known pre-existing conditions or chronic illnesses, primarily due to limited access to healthcare.

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Arora's Assessment

What might be happening

Based on the symptoms you've described, there are several possibilities:

  • Gastroesophageal Reflux Disease (GERD): This condition occurs when stomach acid frequently flows back into the tube connecting your mouth and stomach (esophagus). This backwash (acid reflux) can irritate the lining of your esophagus and cause symptoms like vomiting, especially in the morning or after meals, and chest pain.

    • Treatment typically involves lifestyle changes and over-the-counter medications. In severe cases, prescription medications or surgery might be necessary.

  • Peptic Ulcer Disease: Peptic ulcers are open sores that develop on the inside lining of your stomach and the upper portion of your small intestine. Symptoms of peptic ulcer disease include vomiting, weight loss, and chest pain.

    • Treatment usually involves medications to decrease stomach acid and protect the lining of your stomach and duodenum.

  • Gallstones: These are hardened deposits in the gallbladder that can cause pain in the upper right abdomen and back, as well as nausea and vomiting.

    • Treatment may involve surgery to remove the gallbladder, medications to break up the gallstones, or procedures to remove the stones.

  • Panic Disorder: This is a type of anxiety disorder characterized by recurrent unexpected panic attacks. Panic attacks often cause symptoms like chest pain, difficulty breathing, and shaking.

    • Treatment typically involves psychotherapy and medication.

Please note that these are possibilities based on the symptoms you've described and should not be taken as a definitive diagnosis. It's important to consult with a healthcare provider for an accurate diagnosis.

What you can do

  1. Try to avoid foods and drinks that trigger your symptoms. This might include heavy sauces, fatty foods, chocolate, mint, garlic, onion, and caffeinated drinks such as coffee, tea, and cola. Alcohol and smoking can also worsen GERD symptoms.
  2. Eat smaller meals. Large meals can cause more stomach acid production. Eating smaller meals more frequently can help reduce your symptoms.
  3. Don't lie down after a meal. Wait at least three hours after eating before lying down or going to bed.
  4. Elevate the head of your bed. If you regularly experience heartburn while trying to sleep, put gravity to work for you. Place wood or cement blocks under the feet of your bed so that the head end is raised by 6 to 9 inches.
  5. Don't wear tight clothing or belts that can constrict your stomach.

What you should look out for

You should seek immediate medical attention if you experience:

  • Severe, persistent abdominal pain
  • Bloody or black stools
  • Bloody or black vomit or vomit that looks like coffee grounds
  • Difficulty breathing or shortness of breath that is not relieved by rest
  • Chest pain that radiates to your jaw, left arm, or between your shoulder blades
  • Rapid heartbeat or dizziness, fainting, sweating, or a cold, clammy feeling (these could be signs of a heart attack)

Remember, I'm an AI and this advice is based on the symptoms you've told me. It's really important to consult with a healthcare provider for an accurate diagnosis and treatment.

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9 mo ago

People Also Ask

What are the common symptoms of Gastroesophageal Reflux Disease (GERD)?

Common symptoms of GERD include heartburn, regurgitation of food or sour liquid, difficulty swallowing, chest pain, and vomiting, especially after meals or in the morning.

How can peptic ulcers be treated effectively?

Peptic ulcers are typically treated with medications that reduce stomach acid, such as proton pump inhibitors or H2-receptor antagonists, and medications that protect the stomach lining. In some cases, antibiotics may be needed if the ulcer is caused by H. pylori bacteria.

What are the potential causes of chest pain that radiates to the shoulder blade?

Chest pain that radiates to the shoulder blade can be caused by conditions such as GERD, gallstones, or cardiac issues. It is important to seek medical evaluation to determine the exact cause.

What lifestyle changes can help manage symptoms of GERD?

Lifestyle changes to manage GERD symptoms include avoiding trigger foods and drinks, eating smaller meals, not lying down immediately after eating, elevating the head of the bed, and avoiding tight clothing that can put pressure on the stomach.

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