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Anxiety about muscle pain, jetlag after long flight.

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pain in the heart area and fatigue.
I am a 22 year old woman 164 cm in height and about 55 kg in weight.
I have recently moved to Japan from Norway, I have a health insurance in Japan, but are a bit unsure about wether to go to a clinic, considering my move is so fresh it might all just be jetlag and muscle pain.
I also have a problem with anxiety which can intensify my symptoms. (because my brother suddenly died of heart failure at 21, possibly caused by myocarditis, or a heart defect caused by myocarditis. I don't quite remember what they thought was the most likely cause)

I travelled 4 days ago, the travel was 11 hours in total, the longest flight was eight hours, and I slept poorly. The last time I made this travel I got so sick I couldn't sleep for a week and when I slept waking up felt awful. This time was a lot better only the first day it hurt to wake up, and sleeping was no problem except for the anxiety. Because the same day I arrived I felt pain in the chest area. And noticed that I was really pale and my lips looked blue.
After some days my complexion has improved, and my lips look more normal in color. But I have noticed a fatigue, I tire really easily, I get muscle pains easily (I have been sleeping on a very hard bed though) Especially my back hurts in a way I recognize as muscle pains. In the chest area I sometimes feel a pain like muscle pain on my left side, and sometimes a burning feeling in the center of the chest (mind you I do have a heartburn problem) and right now a cold burning pain in the center of the chest. The pain in the chest I sometimes forget when I'm walking or doing something, but feel when I sit down, it gets worse at night. When I walk my heartbeat easily gets nervous (I have a problem with arrhythmia and bradycardia normally) Since the travel I have also felt dizzy in a way that reminds me of being on a boat. But it was stronger the first day so I think it might just be the moving of the plane that's stuck.
I have also felt that I am not able to eat as much as usual, but the hunger hits me like normal.
I also own a small ECG measuring device, it says everything is normal, but I have seen a big change in the look of the ECG. Right now the R wave is really low and the S wave goes so far down it's off the chart, The ST segment is not level and in some complexes it is raised. On the whole it seems to be going down from the T wave and then up again from the ST segment. I don't know what this means, But just a couple of weeks ago my ECG looked like a normal one, with a high R wave and not so deep S wave, the irregularity lied in the rhythm and occasional skipped beats. Is it bad that my ECG seems to have changed a lot in a short while? It looks different from yesterdays even.
I have not had trouble breathing, I have not had pains in the legs. I don't smoke, I don't use contraceptives or am overweight, but I am not very fit. There are some heart issues in the family. I have lost one grandfather and one great grandfather to heart failure at relatively young age (not my age, theirs) my grandmother has a weak heart and take medicine for it, both my grandmother and mother have arrhythmia.
Should I go to the doctor or should I maybe wait a bit to see if the pain passes?

Category: Internal Medicine Specialist

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Category: HIV- AIDS Specialist
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Thanks for your query at
I understand your concern.
Though heart diseases are less common at your age, considering you family history it can not be completly ruled out.
Heart burn at the centre of the chest, which is unrelated to physical activity, worsing of heartburn during night and obesity all these factors point towards GERD. lifestyle modifications such taking small sized multiple meals, elevating head end of bed while sleep, avoiding cchocolate, alcohol, ssoft drinks, tea, coffee, exercise may help.
ECG interpretation requires quite a skill which can be read by trained physician only. There are different leads which has show different sizes of QRS complexes and T waves normally. I would advice you to do ECG done by a physician and other investigtions like complete blood profile, metabolic profile. Cardiovasucular system examination, blood pressure and ECG will help to exclude diagnosis of heart problems. Your physician may advice you to undergo eosophagoscopy to confirm diagnosis of GERD.
Hope it was helpful
Feel free to discuss further

Patient replied :

I have had esophagoscopy twice, it only confirmed that I had esophagitis. When I did the 24 hour ph measuring of my esophagus it did not show a lot of acid reflux, nothing to say I had GERD atleast. (it was unfortunately measured on one of my good days) The closing mechanism between my esophagus and my stomach seemed fine. But I do have esophagitis and the medicines just barely keep it in check it seems, it still hurts now and then. I take Rantidin and Esomeprazol for this. Aloe vera gel has also seemed to work. My GP in Norway told me there was nothing else to do.
But the pains I have now does not feel like heartburn (only some of it does), it's closer to the skin which is why I was thinking it might be from muscle strain. Now the pain has moved to the left breast and the nipple seems swollen so It might just be irritated. I don't know if an Irritated nipple can cause a burning pain in the breast. Or maybe it's all caused by vagus stimuli?

The pain in the breast could definitely arise from the swollen nipple.
Is the nipple red or is there any discharge? That could indicate a local infection.
Esophagitis if not controlled can be extremely painful and it does not seem like the medicines are working.
Did you ever get tested for H. Pylori? If the medicines have not been able to control, H. Pylori infection could be the cause.

Patient replied :

I do not know if I have been tested for H. Pylori, I know that they did not take any samples during the esophagoscopy. They might I have checked for it on a bloodsample, but if so I was not properly informed.
My nipple is only slightly red in the middle, like it can get from friction. It's slightly darker than normal all over and bigger. There is no discharge.
Right now my pain is in the left side of the chest, in addition to the burning feeling in the skin or under the skin there is a clearer and deeper pain sitting a bit above the left breast. I am confused by the many different pain sensations, is there anything that can cause stinging pain, burning pain and pain that feels like muscle pain in the chest that lasts over days? Or Is it just different causes coincidentally affecting the same area?

There may also be a psychological exaggeration of the symptoms stemming from your previous experience of travel symptoms and an apprehension arising out of a significant family history. The ecg changes, I am not very sure what they mean and can comment if you could upload a strip of ecg. Machine calibration disturbance can lead to shift if baselines. So I feel that these symptoms may be travel fatigue related. But you have a family history of weak hearts and your brother and grandmother suffered from it. So please get some basic tests like 2d echo and a proper ecg along with a hemogram (for blue hue).
Regarding H. Pylori, it is not the part of routine tests unless asked for. The stinging pain could just be from uncontrolled esophagitis. You need a detailed medical gastroenterologist opinion besides the tests I asked for.

Dr. Jaydeep Tripathy
Category: HIV- AIDS Specialist
MBBS from Sri Ramachandra University in December 2011
M.Med (Family Medicine) - TNMGR University, Chennai
MBA-MPH in Public Health in March 2016, SRM University
Finished AFIH in March 2016, SRM University
MRCP ( UK ), Internal Medicine, Royal College of Physicians, June 2016
Fellowship in Diabetology from Martin Luther University in January 2017

Currently Resident Physician, in MD Radiodiagnosis - Kamakshi Memorial Hospital, Chennai
Dr. Jaydeep Tripathy and 4 other Medical Specialists are ready to help you

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