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Forum Name: Rheumatology Topics

Question: Severe chest pain sternum


 Jazzijunk - Tue Oct 25, 2005 11:54 am

I am a 54 year old female diagnosed with GERD, sliding hiatal hernia, laryngospasms, allergies/asthma (mild), and IBS. In 1999, I had my gallbladder removed and wound up in the hospital 8 days. The surgeon said "It was a mess in there. The gallbladder was attached to your omentum. Are you going to have any further testing done?" Foolish me,
I did not go in for my final visit with him so I never asked him why he thought "further testing" should be done. I did tell my primary physician this but nothing ever came of it though I repeatedly ask him to check into it. I have since had an MR of the abdomen and nothing was noted other than three small kidney stones.

My question concerns "incidents" that began about six months ago. The first time I was walking out of a store laughing. I leaned forward only slightly and was suddenly "grabbed" by the most SEVERE pain in the middle of my chest right above my sternum. The pain was so severe that I could not move. If I moved my hips (attempted to walk) the pain intensified. If I moved my neck or arms, the pain intensified also. I felt as though the pain "stabbed or grabbed" me. Breathing was possible but painful. The SEVERE pain lasted for well over a minute. It finally lessened to a point to where I could very slowly take baby steps to reach our vehicle. The pain lasted about five minutes.

I have had this pain at least four other times. It seems to hit me when I lean back. Once I was attempting to raise my hands and "stretch." Two days ago, I leaned my head back under the shower to wet my hair. It is very painful and this time, the pain only radiated down my arms, possible because I did not attempt to move as I was fearful of making the pain worse.

Any ideas what could be the cause of such SEVERE pain?
 Dr. Safaa Mahmoud - Thu Aug 10, 2006 5:32 pm

User avatar Dear Jazzijunk,

The anatomical relation between the diaphragm and the Lowe Esophageal Sphincter LES prevents the gastric acids to come up into the esophagus (reflux). When the upper part of the stomach prolapses through the diaphragm (where the esophagus pass into the abdomen (esophageal hiatus- opening) into the chest, the condition is known as hiatal hernia.

In this condition people will experience one or more of these symptoms, chest pain, especially at night while lying down, swallowing problems and GERD with or without heart burn.

The size of a hiatal hernia and the severity of the symptoms are not correlated. The presence of hitaus hernia aggravates the GERD condition. Acid reflux causes severe pain and discomfort in the chest.

Esophagitis is a known complication of GERD and can lead to esophageal spasm, that can alone give similar clinical picture.

Prokinetic drug that strengthens the sphincter and improves the gastric emptying. When there is an acid reflux it is not enough to treat the symptoms with one drug instead the addition of Anti acids, Acid H2 blockers or proton pump inhibitors mat help to control the symptoms.

Certain foods are known to aggravate the condition, and you better avoid them. These include chocolate, beverages containing caffeine, fatty and fried foods, garlic and onions, spicy and tomato containing foods.

Surgery is considered only if lifestyle changes and medications did not improve the condition or if complications are present.

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