Chest Discomfort, Frequent Hiccups, and Persistent Cough: What to Know

Left chest tightness, persistent hiccups, and continuous coughing?

Hello Doctor, at the beginning of the month, I felt a heaviness in my left chest and sometimes experienced slight weakness in my body.
On the 8th, I went to a cardiologist for an examination, and the doctor mentioned that the electrocardiogram suggested some deformation of the heart.
An echocardiogram and blood tests were performed at that time.
On the 15th, when I reviewed the report, the doctor said that everything seemed fine, with only elevated cholesterol and uric acid levels, and believed that my chest heaviness was likely just a muscle strain (the echocardiogram results were not available at that time).
However, starting from the 10th until around the 16th, I experienced frequent belching after meals (which I rarely did in the past), often continuing for several hours.
Then, around the 17th, I began to have a persistent dry cough throughout the day, especially worsening when preparing to sleep and right after getting up in the morning, although I could sleep through the night without interruption.
Sometimes, I feel a tightness below my throat, particularly when lying on a pillow, as if something is about to get stuck.
This situation continued until around the 19th, when I started to notice some white phlegm, which has been slightly yellow in the past few days.
I visited an otolaryngologist, who only mentioned some inflammation in my throat.
Doctor, I would like to ask if these symptoms are related, and whether I should undergo further examinations for any specific issues.
Thank you.

Da A, 30~39 year old female. Ask Date: 2016/06/22

Dr. Hong Yuanbin reply Internal Medicine

Based on your description, the most likely condition is gastroesophageal reflux disease (GERD).
The characteristics of GERD include symptoms that occur after eating or when lying down, such as a mild burning sensation in the chest, noticeable belching, and in severe cases, throat pain, hoarseness, and increased phlegm production.
If you suspect this, it may be advisable to undergo an upper endoscopy for a definitive diagnosis.
The second possibility is post-nasal drip, where the main symptoms occur when lying down or in cold temperatures, causing the dripping mucus to irritate the respiratory tract, leading to coughing, phlegm, and belching.
As for the possibility of lung or heart diseases, given your age, the likelihood is low.
However, if you are concerned about heart issues, you might consider an electrocardiogram (ECG) and echocardiogram.
If the ultrasound you mentioned refers to a cardiac ultrasound, it would be wise to review the report.
Lung issues are typically detected through a chest X-ray.
If the chest X-ray is normal, the chance of lung disease is low.
If there are still concerns, a chest CT scan could be considered.
If all the above tests return normal, it is indeed more likely that you are experiencing a muscle strain along with a subsequent cold, as both conditions can be managed with symptomatic treatment.
Thank you for your inquiry.

Reply Date: 2016/06/22

More Info

Based on the symptoms you've described—chest discomfort, frequent hiccups, persistent cough, and a feeling of tightness in your throat—there are several potential underlying causes that could be interconnected. It is essential to consider both respiratory and gastrointestinal factors, as well as any possible musculoskeletal issues.

Possible Connections Between Symptoms
1. Gastroesophageal Reflux Disease (GERD): Frequent hiccups and a sensation of tightness in the throat can often be attributed to GERD. This condition occurs when stomach acid flows back into the esophagus, leading to irritation and inflammation. The cough you are experiencing, especially when lying down or after meals, could be a reflex response to acid irritation in the throat or esophagus. The presence of white or yellow phlegm may indicate that your body is trying to clear the irritation caused by reflux.

2. Musculoskeletal Issues: Your initial chest discomfort was attributed to a possible muscle strain. If you have been experiencing muscle tension or strain in the chest area, this could lead to discomfort that might be mistaken for cardiac issues. Muscle strain can also cause referred pain or discomfort that may feel like it is affecting your breathing or causing tightness in the throat.

3. Respiratory Infections or Inflammation: The persistent cough, especially if it has progressed to producing phlegm, could indicate a respiratory infection, such as bronchitis or even a post-viral cough following a cold. The inflammation in your throat noted by the ENT specialist could also contribute to your cough and the sensation of tightness.

4. Anxiety and Stress: Psychological factors can also play a role in physical symptoms. Anxiety can manifest as chest tightness, frequent hiccups, and a persistent cough. If you have been feeling stressed or anxious, this could exacerbate your physical symptoms.

Recommendations for Further Evaluation
Given the complexity of your symptoms, it would be prudent to consider the following steps:
1. Gastroenterology Consultation: Since GERD is a strong possibility, consulting a gastroenterologist for further evaluation may be beneficial. They might recommend lifestyle modifications, dietary changes, or medications to manage reflux symptoms.

2. Pulmonary Function Tests: If your cough persists, a pulmonologist can conduct tests to assess your lung function and rule out conditions like asthma or chronic obstructive pulmonary disease (COPD).

3. Imaging Studies: If your symptoms do not improve or worsen, consider discussing the need for imaging studies, such as a chest X-ray or CT scan, to rule out any structural issues in the lungs or chest cavity.

4. Musculoskeletal Assessment: If muscle strain is suspected, a physical therapist can provide exercises and stretches to alleviate discomfort and improve your posture.

5. Monitoring Symptoms: Keep a detailed log of your symptoms, including when they occur, their severity, and any potential triggers. This information can be invaluable for your healthcare providers in diagnosing the issue.

Conclusion
While your symptoms may seem alarming, they can often be managed effectively with the right approach. It is essential to communicate openly with your healthcare providers about your concerns and symptoms. They can guide you through the diagnostic process and help you find relief. Remember to prioritize your mental well-being as well, as stress and anxiety can significantly impact physical health.

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