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When I was a senior medical student I used to stay late at the hospital. One day at the emergency department around 8 pm a patient walked in with upper stomachache and mild chest pain. The intern examined the patient and took a quick history; I was watching. The intern was more concerned about gastrointestinal issues because the patient came in with stomach pain. An hour later the patient left the hospital with a prescription for pain meds a long with a list of gastrointestinal tests. 20 minutes later he was brought back by an ambulance, this time he was having a full blown heart attack.
In this case scenario the mild chest pain was a much more important symptom than a stomach pain.
Chest pain is one of the most common symptoms for which adults seek medical care. Evaluating the characteristics of the pain is extremely important.
9 out of 10 chest pain cases could be diagnosed only by pain characteristics. The first goal is to determine whether the pain is caused by a heart issue. Every person with chest pain should have an ECG done, this simple non-invasive test is very important to diagnose or rule out ischemic heart disease.
Esophageal disease (GERD) is a common cause of recurrent chest pain. This is usually secondary to acid reflux from the stomach. The acid damages the esophageal mucosa, resulting in burning type pain. Chest pain caused by esophageal reflux usually occurs after meals and you lie down. They often occur at night when you lie down to sleep. This pain is relieved by antacids.
Esophageal Spasm The pain is unrelated to body position. Dysphagia is frequently a prominent symptom.
Myocardial ischemia causes recurrent chest pain. This is probable the scariest condition causing chest pain. The pain is pressure like and comes usually during physical activity. This pain is not usually aggravated by lying down. ECG is the best initial test to diagnose this condition.
Mitral valve prolapse can cause pain that is aggravated by lying down.
Pericarditis frequently causes chest pain. This sharp pain is aggravated by lying down and improved by sitting up. The electrocardiogram and echocardiogram are diagnostic.
Cardiomyopathy is also a possible cause of chest pain that is aggravated by lying down.
Cardiomyopathy symptoms include:
- Shortness of breath with exertion or even at rest in more advanced stages,
- Edema (Swelling of the legs, ankles and feet due to fluid buildup),
- Irregular rapid heartbeats, pounding or fluttering,
- Dizziness, lightheadedness and fainting.
Please visit your doctor if you have these symptoms, Cardiomyopathy tend to get worse unless treated.
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