[58M] With sharp, episodic chest pain and belching

Patient Description

A 58-year-old male presents with sharp, episodic chest pain located on the left side of the back, which started suddenly two days ago. The pain is mostly continuous with a few brief pain-free episodes and is rated at 8-9 out of 10 in severity. Shortness of breath occurs when the pain peaks. The patient reports that applying heat provides significant relief. He suspects a musculoskeletal issue, although there is no history of trauma. The patient also experiences continuous belching, which has become more prominent since the onset of pain and seems to be triggered by raw vegetables. Massaging the area leads to increased belching. The patient's medical history includes diabetes and dyspepsia for the past 10 years. Current medications include Empagliflozin, Metformin, Omeprazole, and Amaryl, with Nuberol Forte and Thiolax taken temporarily for pain relief. The patient has an allergy to Ropinirole, which was discontinued after two doses six months ago.

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Arora's Assessment

What might be happening

Based on the symptoms you've described, here are some possible explanations:

  1. Musculoskeletal Pain: Given the sudden onset of sharp, episodic pain in the back of your chest, it could be related to a musculoskeletal issue, such as a muscle strain or spasm. The relief you experience from applying heat and the absence of trauma support this possibility. Musculoskeletal pain can sometimes be accompanied by swelling in the affected area.

  2. Gastroesophageal Reflux Disease (GERD): Your history of dyspepsia and the continuous belching, especially after eating raw vegetables, suggest that GERD might be contributing to your symptoms. GERD can cause referred pain to the chest and back, and belching is a common symptom.

  3. Diabetic Neuropathy: Although less likely, diabetes can sometimes lead to neuropathic pain, which might manifest as sharp, episodic pain. However, this is less common in the chest area.

Typical treatments for musculoskeletal pain include rest, heat application, and over-the-counter pain relief. For GERD, dietary modifications, antacids, and medications like omeprazole can help manage symptoms. It's important to consult a healthcare professional for a proper diagnosis and treatment plan.

What you can do

  1. Continue Applying Heat: Since heat has been helpful, continue using a heating pad on the affected area to alleviate pain.

  2. Monitor Your Diet: Keep track of foods that trigger belching and discomfort. Avoid raw vegetables and other known triggers to see if symptoms improve.

  3. Use MDandMe: Consider using the MDandMe app to journal your symptoms, track your progress, and share insights with your healthcare provider. This can help in identifying patterns and triggers.

  4. Pain Management: Continue using over-the-counter pain relief as needed, but consult your doctor if the pain persists or worsens.

What you should look out for

  • Seek Immediate Medical Attention: If you experience severe chest pain, shortness of breath, or any new symptoms, seek medical help immediately, as these could be signs of a more serious condition.

  • Monitor for Changes: Keep an eye on any changes in your symptoms, such as increased swelling, pain intensity, or new symptoms like fever.

  • Consult Your Doctor: If your symptoms do not improve with self-care measures or if you have concerns about your condition, schedule an appointment with your healthcare provider for a thorough evaluation.

Remember, while this information can be helpful, it's important to consult a healthcare professional for a formal diagnosis and treatment plan.

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1 mo ago


People Also Ask


What are the common causes of sharp, episodic chest pain?

Common causes of sharp, episodic chest pain include musculoskeletal issues like muscle strain or spasm, gastroesophageal reflux disease (GERD), and less commonly, conditions like diabetic neuropathy. It's important to rule out more serious conditions like cardiac issues.


How can GERD lead to chest and back pain?

GERD can cause chest and back pain due to the reflux of stomach acid irritating the esophagus, which can lead to referred pain. This pain can sometimes be felt in the chest and back, mimicking musculoskeletal pain.


What dietary changes can help manage symptoms of GERD?

To manage GERD symptoms, it is recommended to avoid trigger foods such as raw vegetables, spicy foods, caffeine, and alcohol. Eating smaller, more frequent meals and avoiding lying down immediately after eating can also help reduce symptoms.


What are the potential side effects of the medications the patient is taking?

The medications the patient is taking, such as Empagliflozin, Metformin, Omeprazole, and Amaryl, can have side effects like gastrointestinal issues, changes in blood sugar levels, and potential interactions with other medications. It's important to monitor for any adverse effects and consult a healthcare provider if they occur.


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