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Moderate central burning chest pain on and off in depressed woman

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I am a 29 year old female, and I have had moderate central, burning chest pain on and off for about 3 days. It is not worsened by activity, and is persistently present at rest. I have been very tired, and have also had occasional coughing, but no shortness of breath. I do not smoke, and I have no personal or family cardiac history, but I do have mild hypertension, for which I take atenolol 25mg. I have a history of heartburn, but this feels... different. I also have bipolar II, and have been very (unusually) depressed in the past week or so. I take abilify and wellbutrin for the bipolar symptoms. I have been working with my psychiatrist on the depression, and mentioned this chest pain to him, but he didn't seem to think much of it, saying it was probably a symptom of the depression. I tried tylenol (also for a crashing headache), and that did not improve the chest pain at all.

So, here is my question: In your professional opinion, what is the likelihood that my chest pain is, in fact, just a symptom of being depressed... and when should I seek further evaluation? I realize that I don't really have any risk factors for heart attack, which is reassuring. Since I am currently uninsured and out of a job, I would very much like to avoid an ER trip, especially by ambulance.

Thank you for your help.

Category: Family Physician-GP

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Category: HIV- AIDS Specialist
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Thank you for asking your query at DoctorSpring.

From symptom analysis your chest pain is NOT likely to be of Cardiac origin. A non cardiac chest pain - possibly an ulcer related / GERD pain is more likely. I do understand that pain differs from your heart burn pain, but still a GERD is very much likely. Anyhow to be sure please let me know whether you have the following symptoms or features. You can reply as a followup.

1. Is the pain radiating ? Like to the arms or neck ?
2. Is there any sweating / nausea / vomiting / syncope when the pain comes ?
3. Does this pain has any relationship with food intake ? Like skipping a meal aggregates it ?
4. Can you sleep comfortably at night ? Are you troubled by the pain ?

Thank you

Patient replied :

Thank you for your reply. Here are the answers to your questions:

1. No radiation.
2. Yes, I have also been having intermittent flushing and sweats, also intermittent nausea without vomiting, but this does not always occur in direct conjunction with the pain. The pain is fairly constant, and those come and go.
3. I haven't been eating a whole lot lately, so it's hard to say. I haven't noticed a correlation such as that the pain improves after meals.
4. The pain is obnoxious and is troubling me, and I am not sleeping well (it's currently about 3:20 am here), but I don't think the pain is the cause of my waking at night. It does not worsen when I'm lying down vs. sitting.

To test your GERD theory, I just tried a pepcid complete... it does not seem to be helping. :(

Thanks again.

Thank you for the additional information. Considering the nature of symptoms, family history, medical history and the additional details you have provided, Chest pain of Cardiac origin is less likely. But it is never possible to rule out a heart condition 100% without further investigation. Although with symptom analysis it is reasonably sure than the pain is non cardiac, I recommend getting an ECG done if the pain is persistent and troubling.

GERD / Ulcer dyspepsia is possible even though pepcid did not give you a relief. You will need to take the medicaiton for 7-14 days to see appreciable benefit. I recommend OTC Prilosec as it is a better alternative.

Hope this helps
Please feel free to ask followup questions / clarifications.

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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