[27M] With chest pain and tenderness

Patient Description

A 27-year-old male presents with a bubble-like pressure and menthol feeling in the center of his chest for the past 4 hours. The pain is moderate, rated 3.5/10, and worsens with sitting still or being in the heat. Walking around alleviates the pain. The patient also feels slightly faint and reports tenderness to the touch in the chest area. He has a history of heartburn and acid reflux, currently experiencing heartburn, regurgitation when burping, and nausea. There is no shortness of breath or pain radiating to the arms, neck, jaw, or back. The patient was diagnosed with aortic stenosis two weeks ago and high blood pressure one year ago. He is taking 10mg of Propranolol once daily for high blood pressure and 25mg of Hydroxyzine as needed for anxiety. There are no known drug allergies and no use of over-the-counter medications, supplements, or herbal remedies.

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Arora's Assessment

What might be happening

Based on the symptoms and history you've provided, here are some possible explanations for your condition:

1. Gastroesophageal Reflux Disease (GERD)

  • Rationale: Your history of heartburn and acid reflux, along with current symptoms of heartburn, regurgitation, and nausea, suggest that GERD could be a contributing factor. GERD can cause chest pain that feels like pressure and can sometimes be mistaken for heart-related pain.
  • Typical Treatments: Lifestyle changes (diet modification, weight loss), over-the-counter antacids, H2 blockers, or proton pump inhibitors (PPIs). In severe cases, prescription medications or surgery may be needed.

2. Aortic Stenosis

  • Rationale: Given your recent diagnosis of aortic stenosis, this condition could also be contributing to your chest pain and slightly elevated heart rate. Aortic stenosis can cause chest pain, especially during physical activity or stress.
  • Typical Treatments: Monitoring by a cardiologist, medications to manage symptoms, and in severe cases, surgical interventions like valve repair or replacement.

3. Anxiety

  • Rationale: Anxiety can manifest with physical symptoms such as chest pain, a feeling of pressure, and a rapid heart rate. Your use of Propranolol for anxiety suggests that this could be a contributing factor.
  • Typical Treatments: Cognitive-behavioral therapy (CBT), medications like SSRIs or benzodiazepines, and lifestyle changes such as stress management techniques.

Unifying Diagnosis

  • Rationale: It's possible that your symptoms are due to a combination of GERD, aortic stenosis, and anxiety. Each of these conditions can contribute to chest pain and other symptoms you're experiencing.

What you can do

Chest Pain and Elevated Heart Rate

  • Seek Immediate Medical Attention: Given your history of aortic stenosis and current symptoms, it's important to seek medical attention as soon as possible to rule out any serious cardiac issues.
  • Avoid Triggers: Try to avoid activities or situations that worsen your chest pain, such as sitting still for long periods or being in the heat.
  • Stay Hydrated and Cool: Drink plenty of water and stay in a cool environment to help manage your symptoms.

GERD Symptoms

  • Dietary Changes: Avoid foods and drinks that trigger your heartburn, such as spicy foods, caffeine, and alcohol.
  • Elevate Your Head: When sleeping, elevate the head of your bed to prevent acid reflux.
  • Over-the-Counter Medications: Consider using antacids or H2 blockers to manage your symptoms.

Anxiety Management

  • Relaxation Techniques: Practice relaxation techniques such as deep breathing, meditation, or yoga to help manage your anxiety.
  • Regular Exercise: Engage in regular physical activity, which can help reduce anxiety and improve overall well-being.
  • Use MDandMe: Journal your symptoms, track your progress, and share your notes with your healthcare provider for better management of your condition.

What you should look out for

Given the severity of your symptoms and the potential for serious underlying conditions, you should seek medical care as soon as possible. Reasons to seek care even more urgently include:

  • Worsening Chest Pain: If your chest pain becomes more severe or does not improve with rest.
  • Shortness of Breath: If you experience shortness of breath, fainting, or dizziness.
  • New Symptoms: If you develop new symptoms such as arm pain, jaw pain, or severe headache.

Remember, while I can provide information and suggestions, it's important to consult with a healthcare professional for a formal diagnosis and appropriate treatment.

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5 mo ago


People Also Ask


What are the common symptoms of GERD and how can they be managed?

Common symptoms of GERD include heartburn, regurgitation, nausea, and chest pain. Management typically involves lifestyle changes such as diet modification, weight loss, and avoiding trigger foods. Over-the-counter antacids, H2 blockers, or proton pump inhibitors (PPIs) can also be used to reduce symptoms.


How does aortic stenosis contribute to chest pain and what are the treatment options?

Aortic stenosis can cause chest pain, especially during physical activity or stress, due to the narrowing of the aortic valve which affects blood flow. Treatment options include regular monitoring by a cardiologist, medications to manage symptoms, and in severe cases, surgical interventions like valve repair or replacement.


Can anxiety cause physical symptoms like chest pain and how can it be treated?

Yes, anxiety can cause physical symptoms such as chest pain, a feeling of pressure, and a rapid heart rate. Treatment options include cognitive-behavioral therapy (CBT), medications like SSRIs or benzodiazepines, and lifestyle changes such as stress management techniques.


What lifestyle changes can help manage heartburn and acid reflux?

Lifestyle changes to manage heartburn and acid reflux include avoiding foods and drinks that trigger symptoms, such as spicy foods, caffeine, and alcohol. Elevating the head of the bed when sleeping and staying hydrated can also help. Over-the-counter medications like antacids or H2 blockers may be used to alleviate symptoms.


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