Chest Pain and Throat Discomfort: Possible Causes and Next Steps

Chest pain and a sensation of a foreign body in the throat?

About eight months ago, I started feeling a strange sensation in the center of my chest.
I went to a pulmonologist for an X-ray, and the doctor said everything looked normal, so I didn't think much of it.
However, in the past few months, it has gradually developed into chest pressure and pain (the pain occurs when I press on the area or when I perform adduction movements with my pectoral muscles).
Above the pain point, I feel tightness in the esophagus when swallowing saliva, as if there is phlegm or something stuck.
My throat also feels constricted, and my tongue occasionally develops a white coating that started at the base and now covers the entire tongue, which I can't seem to clean off.
I visited a gastroenterologist for an endoscopy and a Helicobacter pylori test, and the doctor thought it didn't seem like gastroesophageal reflux disease, just a bit of excess stomach acid, possibly due to muscle inflammation.
I was advised to do more deep breathing and chest expansion exercises, but there hasn't been much improvement, and the symptoms persist.
Could this be indicative of another issue, such as tuberculosis or something else causing pain in that area? What further examinations would be appropriate? Thank you for your response.

ZERO, 30~39 year old female. Ask Date: 2010/11/24

Dr. Yang Wenda reply Pulmonology

Your chest X-ray is normal and there are no symptoms related to tuberculosis.
If you do not recall any contact with tuberculosis patients, your discomfort should not be related to tuberculosis.
Please avoid intentionally pressing or performing chest expansion exercises.
Adequate rest or soaking in warm water should help improve your condition.
For the thick tongue coating, it is recommended to consult a traditional Chinese medicine practitioner, and it is also advised to limit the intake of cold fruits and foods.
Best wishes!

Reply Date: 2010/11/24

More Info

Understanding chest pain and throat discomfort can be quite complex, as these symptoms can arise from a variety of underlying conditions. Based on your description, it appears that you have been experiencing a progression of symptoms over the past several months, starting with a vague discomfort in the center of your chest and evolving into more pronounced chest pressure and pain, particularly when you engage in certain movements or actions, such as pressing on your chest or performing internal shoulder movements. Additionally, the sensation of tightness in your esophagus when swallowing, along with the feeling of something stuck in your throat, adds another layer of concern.

Given that you have already undergone an X-ray and a gastroscopy (endoscopy) with tests for Helicobacter pylori, and that these tests did not reveal any significant abnormalities, it is essential to consider other potential causes for your symptoms. Here are some possibilities:
1. Musculoskeletal Issues: The pain you describe, especially when pressing on your chest or during certain movements, could be related to musculoskeletal problems, such as costochondritis (inflammation of the cartilage connecting the ribs to the sternum) or muscle strain. These conditions can cause localized pain and discomfort that may mimic more serious cardiac issues.

2. Gastroesophageal Reflux Disease (GERD): Although your gastroenterologist suggested that it might not be classic GERD, increased acid production can still lead to symptoms such as chest discomfort and a sensation of tightness in the throat. The feeling of something stuck in your throat could also be related to esophageal spasms or inflammation.

3. Anxiety and Stress: Psychological factors can significantly contribute to physical symptoms, including chest pain and throat discomfort. Anxiety can lead to muscle tension, which may exacerbate feelings of tightness and discomfort in the chest and throat.

4. Esophageal Disorders: Conditions such as esophageal motility disorders or even eosinophilic esophagitis (an allergic inflammatory condition) could lead to the symptoms you are experiencing. These conditions can cause difficulty swallowing and a sensation of food being stuck.

5. Infectious Causes: While you mentioned concerns about tuberculosis, it is less likely given the absence of other systemic symptoms (like fever, night sweats, or weight loss). However, if you have a history of exposure or other risk factors, it may be worth discussing further testing with your healthcare provider.

6. Other Considerations: Conditions such as pleuritis (inflammation of the lining of the lungs), pulmonary embolism, or even cardiac issues should not be ruled out entirely, especially if your symptoms worsen or if you experience new symptoms such as shortness of breath, dizziness, or radiating pain.

Next Steps:
- Follow-Up with Your Doctor: Given the persistence of your symptoms, it would be prudent to follow up with your primary care physician or a specialist. They may recommend further imaging studies, such as a CT scan of the chest, or additional tests to evaluate esophageal function.

- Consider a Referral: If you have not already seen a specialist in gastroenterology or pulmonology, a referral may provide more insight into your symptoms.

- Lifestyle Modifications: In the meantime, consider lifestyle changes that may alleviate symptoms, such as dietary modifications, stress management techniques, and exercises that promote relaxation and deep breathing.

- Monitor Symptoms: Keep a detailed log of your symptoms, noting when they occur, their intensity, and any associated factors. This information can be invaluable for your healthcare provider in diagnosing your condition.

In conclusion, while your symptoms may not indicate a life-threatening condition, they warrant further investigation to ensure an accurate diagnosis and appropriate management. Please do not hesitate to seek medical attention if your symptoms worsen or if you have any new concerns.

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