[20M] Experiencing chest pain and palpitations without clear triggers

Patient Description

A 20-year-old male has been experiencing aching chest pain that spreads to the shoulders and back for about a year, rated 4-5 on a pain scale. The pain sometimes worsens with deep breaths but occurs randomly, often while resting. Heart palpitations are also present, though without accompanying fatigue or dizziness. The patient has a family history of type 2 diabetes and heart disease, with his father having had a heart attack at a similar age. Past medical history includes an appendectomy at age 7. Currently, the patient is taking Meloxicam (7.5 mg daily) for a couple of months, along with daily supplements of iron (60 mg), vitamin C (2000 mg), and vitamin D (2000 UI). There are no known drug allergies, and the patient denies the use of tobacco, alcohol, or recreational drugs. No recent illnesses or infections have been reported. The symptoms, including occasional difficulty breathing and frequent headaches, do not seem to be influenced by recent illnesses, substance use, or specific activities.

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Arora's Assessment

What might be happening

Based on the information you've provided, possible diagnoses include:

  • Costochondritis: This is an inflammation of the cartilage in your rib cage. The condition causes chest pain that can spread to your back or abdomen. It can be caused by heavy lifting, strenuous exercise, or upper respiratory illnesses. It's usually treated with rest, physical therapy, and nonsteroidal anti-inflammatory drugs (NSAIDs) like Meloxicam.
  • 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 chest pain. Treatment usually involves lifestyle changes and over-the-counter medications.
  • Anxiety: Chest pain is a common symptom of panic attacks and anxiety. Other symptoms can include heart palpitations, shortness of breath, and headaches. Treatment usually involves cognitive behavioral therapy and medication.

Please note that chest pain can also be a symptom of serious heart conditions, such as angina or a heart attack. However, these conditions are less common in people your age and usually cause more severe symptoms.

What you can do

  1. Continue taking Meloxicam as prescribed by your doctor. This medication can help reduce inflammation and relieve pain.
  2. Try to identify any triggers for your chest pain. This could include certain activities, foods, or stressors. Avoiding these triggers can help manage your symptoms.
  3. Practice good posture. Poor posture can sometimes contribute to chest and back pain.
  4. If your symptoms persist or worsen, seek medical attention. Your doctor may want to perform further tests to determine the cause of your chest pain.

What you should look out for

Seek immediate medical attention if you experience any of the following:

  • Severe chest pain
  • Chest pain accompanied by shortness of breath, dizziness, fainting, or nausea
  • Chest pain that spreads to your jaw, left arm, or back
  • Chest pain that gets worse with physical activity
  • Chest pain that doesn't improve with rest or medication

Remember, I'm an AI and not a doctor. Always consult with a healthcare professional for a formal diagnosis and treatment.

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8 mo ago


People Also Ask


What is costochondritis and how is it treated?

Costochondritis is an inflammation of the cartilage in the rib cage, causing chest pain that can spread to the back or abdomen. It is usually treated with rest, physical therapy, and nonsteroidal anti-inflammatory drugs (NSAIDs) like Meloxicam.


Can GERD cause chest pain and how is it managed?

Yes, GERD can cause chest pain due to acid reflux irritating the esophagus. Management typically involves lifestyle changes such as diet modification and over-the-counter medications to reduce stomach acid.


How can anxiety contribute to chest pain and what are the treatment options?

Anxiety can cause chest pain as a symptom of panic attacks, along with heart palpitations and shortness of breath. Treatment options include cognitive behavioral therapy and medication to manage anxiety symptoms.


When should I seek immediate medical attention for chest pain?

Seek immediate medical attention if you experience severe chest pain, chest pain with shortness of breath, dizziness, fainting, nausea, pain spreading to the jaw, left arm, or back, or if the pain worsens with physical activity and doesn't improve with rest or medication.


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10 Comments


Leo#3962

8 mo ago

If your father had a heart attack at a young age and you've been experiencing random chest pains at rest, you really should see a cardiologist asap to make sure your not experiencing pain from lack of bloodflow to your heart

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Leo#3962

8 mo ago

How are your cholesterol levels if you've gotten them checked?

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Anonymous#4752

8 mo ago

I have an appointment with a cardiologist later this month. I've been to the doctor with this concern, and every test they've done has come back normal. I've been told my heart appears healthy and my diet is good. That's what causes my worry. If nothing seems to be wrong, why am I experiencing this pain?

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Leo#3962

8 mo ago

Oh okay. Did they already do a cardiac stress test?

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Anonymous#4752

8 mo ago

I have not had that done yet

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Leo#3962

8 mo ago

Would definitely push to do that when you see your cardiologist. Or another study that can characterize the blood perfusion of your heart. If your heart blood vessels are fine, then the other likely cause of your chest pain is acid reflux, as basic as it sounds. You could try taking over-the-counter omeprazole or other GERD medication

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Anonymous#4752

8 mo ago

I'll definitely ask about it. Thanks for the help!

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Tate McEwan#4033

8 mo ago

Has the Meloxicam helped with the symptoms at all?

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Anonymous#4752

8 mo ago

It helps for a couple of hours and then the pain comes back.

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Leo#3962

8 mo ago

Did you end up getting more insight into what's going on?

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