Dizziness and Chest Discomfort After Meals: A Medical Perspective

Experiencing dizziness and chest tightness with a desire to take deep breaths often occurs after lunch or during meals?

Mid-February: After dinner (Big Mac) at 7:00 PM, I felt dizzy and had chest tightness, which made me want to take deep breaths.
The dizziness was severe enough that I needed to lie down and rest.
At that time, I was recovering from a cold, so I went to see an ENT specialist.
There were no specific symptoms, and the doctor suggested it might be a gastric issue.
On February 28: The first sputum I coughed up that morning contained blood, but it gradually stopped.
I felt unwell, particularly with chest tightness, and experienced the same symptoms after lunch (sweet potato noodles), so I visited a gastroenterologist.
The doctor diagnosed me with gastroesophageal reflux disease (GERD) due to the chest tightness (without chest pain), occasional awakenings during sleep, and dizziness in some cases.
After starting medication, I did not experience any issues.
On March 5: Sometimes before meals and sometimes after, I still felt chest discomfort and the urge to take deep breaths, followed by feelings of anxiety (or palpitations? I'm not sure), so I went to see a family medicine doctor.
That day, I underwent an electrocardiogram and X-rays, which showed no significant abnormalities.
The doctor suggested it might be a psychological factor and prescribed anti-anxiety medication.
Early March: After a full-body massage at 7:00 PM, I took a couple of bites of dinner (beef noodles) and experienced chest discomfort, loss of appetite, and a heavy head (but I was still able to ride my bike).
The next day, I visited a pulmonologist and underwent an electrocardiogram and X-rays again, with no significant findings, and it was again attributed to psychological factors.
Mid-March: Occasionally, after meals, I took gastrointestinal medication, which seemed to help.
On March 25: The previous night, due to nasal allergies, I took over-the-counter medication.
At 5:00 AM, I woke up suddenly and vomited, expelling a clear liquid with a slight yellowish tinge, possibly gastric acid.
The first sputum I coughed up while clearing my throat contained some blood.
After that meal, I experienced stomach pain and bloating.
I returned to the gastroenterologist, who diagnosed me with some bloating, suggesting that the stomach pain might have been caused by vomiting, and reiterated that it was likely a GERD issue.
On March 29: At 1:00 PM, after having soup, bread, and baked chicken with pesto, I felt dizzy after taking a couple of bites, my face felt warm, and I had the sensation of something rising up, prompting me to take deep breaths.
I switched to another gastroenterologist, who stated that "gastrointestinal issues shouldn't cause dizziness, but it's not impossible," and suggested an endoscopy; if that showed no issues, I could consider seeing a neurologist.
That evening, after dinner (shredded meat fried rice), I did not experience any significant symptoms.
In summary, I have been experiencing "dizziness," "chest tightness with the urge to take deep breaths," "gastric discomfort," and "feelings of anxiety," and I am unsure which specialty to consult.
Should I switch to a neurologist, a neurology specialist, or a cardiologist, or should I continue seeing a gastroenterologist?

Mr. Hong, 30~39 year old female. Ask Date: 2019/03/29

Dr. Cai Dongqi reply Family Medicine

Hello, based on the symptoms you described, it seems you may be experiencing psychosomatic issues due to life stress rather than a specific disease.
The focus should be on gastrointestinal health and lifestyle adjustments.
I recommend that you consult a psychiatrist or a specialist in psychosomatic medicine.

Reply Date: 2019/03/29

More Info

Dizziness and chest discomfort after meals can be quite distressing and may stem from various underlying conditions. Based on your detailed medical history, it appears that you have been experiencing a range of symptoms including dizziness, chest tightness, and gastrointestinal issues. These symptoms can be interconnected, and understanding their potential causes is crucial for effective management.

Firstly, your symptoms of dizziness and chest discomfort after meals could be related to gastrointestinal issues such as gastroesophageal reflux disease (GERD), which has been suggested by your healthcare providers. GERD can cause chest discomfort that mimics heart-related pain, often described as a burning sensation or tightness in the chest. This discomfort can sometimes lead to anxiety, which may exacerbate feelings of dizziness or lightheadedness. The connection between the gastrointestinal tract and the nervous system is well-documented, and symptoms from one system can influence the other.

Additionally, the episodes of dizziness you described, particularly after meals, could also be attributed to postprandial hypotension, a condition where blood pressure drops significantly after eating. This can lead to feelings of lightheadedness or faintness, especially if you have consumed a large meal or one high in carbohydrates. The body directs more blood to the digestive system during digestion, which can sometimes result in insufficient blood flow to the brain, causing dizziness.

Your mention of experiencing blood in your sputum and subsequent vomiting raises concerns that should not be overlooked. While it may be related to a gastrointestinal issue, such as irritation from reflux or esophagitis, it is essential to rule out more serious conditions. Blood in sputum can indicate a respiratory issue or even a more severe gastrointestinal problem, and it warrants further investigation.

Given the complexity of your symptoms and the various specialists you have consulted, it may be beneficial to continue working with a gastroenterologist, as they can provide insights into both gastrointestinal and potential overlapping issues. However, if your symptoms persist or worsen, particularly the dizziness and any neurological symptoms, it would be prudent to seek an evaluation from a neurologist. They can assess for any underlying neurological conditions that may be contributing to your symptoms.

In summary, your symptoms of dizziness, chest discomfort, and gastrointestinal distress could be interrelated, possibly stemming from GERD, postprandial hypotension, or anxiety. It is essential to maintain open communication with your healthcare providers and consider further evaluations, including an upper endoscopy if GERD is suspected, and possibly imaging or neurological assessments if symptoms persist. Keeping a symptom diary may also help your doctors identify patterns and triggers, leading to a more accurate diagnosis and effective treatment plan. Remember, your health is paramount, and seeking clarity on your symptoms is a vital step toward recovery.

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