[78M] Experiencing chest pain with exertion and at rest

Patient Description

A 78-year-old male reports experiencing chest pain that started about 7 days ago. The pain, described as a tightening pressure in the middle of the chest radiating to the back, is rated as a 6 on a scale of 1-10, with episodes lasting up to 1 hour. The pain occurs both upon waking and with exertion, such as walking less than two blocks. The episodes are associated with sweating, arm weakness, and are often relieved by burping. The patient has a history of smoking for 44 years but quit 18 years ago and is slightly overweight. He has no known allergies and his family has no history of heart disease. His recent physical examination, including an echocardiogram and stress test, was normal. He is currently on medications for blood pressure (Chlorthalidone, Amlodipine), arthritis pain (Diclofenac), heartburn (Pantoprazole as needed), prostate issues (Tamsulosin), and potassium supplementation (Potassium Chloride). He also takes Vitamin D supplements intermittently and uses herbal tea with senna for constipation.

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Arora's Assessment

What might be happening

Based on the information you've provided, the possible explanations for your symptoms could include:

  • Angina: This is chest pain or discomfort caused when your heart muscle doesn't get enough oxygen-rich blood. It often happens when the heart is working harder than usual, like during physical activity or emotional stress. The pain can also spread to your arms, shoulders, jaw, neck, or back. Angina can feel like pressure or squeezing in your chest.

    • Treatment typically involves lifestyle changes, medications, and sometimes, surgery.
  • Gastroesophageal Reflux Disease (GERD): This is a chronic condition where 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 heartburn. The fact that burping seems to alleviate your symptoms could suggest this diagnosis.

    • Treatment typically involves lifestyle changes and over-the-counter medications. If these don't help, prescription medications or even surgery might be necessary.
  • Gallbladder Disease: The gallbladder is a small organ under the liver that stores bile, a digestive fluid produced by the liver. Gallbladder disease includes inflammation, infection, stones, or blockage of the gallbladder. Symptoms can include pain in the center or right upper part of the abdomen, often accompanied by nausea and vomiting.

    • Treatment depends on the specific type of gallbladder disease, but can include dietary changes, medications, or surgery.

What you can do

Given the nature of your symptoms, it's important that you seek immediate medical attention. Chest pain can be a sign of serious heart problems, and it's important to rule this out as soon as possible.

In the meantime, try to rest and avoid any activities that seem to trigger your symptoms.

What you should look out for

Seek immediate medical attention if you experience:

  • Severe chest pain or discomfort
  • Pain that spreads beyond your chest to other areas of your body, such as your arms, shoulders, jaw, neck, or back
  • Shortness of breath, rapid breathing, or any difficulty breathing
  • Dizziness, fainting, or loss of consciousness
  • Sweating or a cold sweat
  • Nausea or vomiting
  • A rapid or irregular heartbeat

Please remember that while I strive to provide accurate and helpful information, I am an AI and not a doctor. Always consult with a healthcare professional for a formal diagnosis and treatment.

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9 mo ago


People Also Ask


What are the common symptoms of angina and how is it treated?

Common symptoms of angina include chest pain or discomfort, often described as pressure or squeezing, that may radiate to the arms, shoulders, jaw, neck, or back. It typically occurs during physical activity or stress. Treatment involves lifestyle changes, medications, and sometimes surgery.


How can GERD cause chest pain and what are the treatment options?

GERD can cause chest pain due to acid reflux irritating the esophagus. This pain can mimic heart-related chest pain. Treatment includes lifestyle changes, over-the-counter medications, and possibly prescription medications or surgery if symptoms persist.


What are the signs of gallbladder disease and how is it managed?

Signs of gallbladder disease include pain in the center or right upper part of the abdomen, often accompanied by nausea and vomiting. Management depends on the specific condition but may involve dietary changes, medications, or surgery.


When should someone seek immediate medical attention for chest pain?

Immediate medical attention for chest pain is necessary if the pain is severe, spreads to other parts of the body, is accompanied by shortness of breath, dizziness, sweating, nausea, or an irregular heartbeat.


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