I'm having heartburn in the center of my chest Different

Patient

Q: I'm having heartburn in the center of my chest. Different from what I experienced in the past. It's more intermittent. I also have been feeling light headed when I get down and stand back up. This is also new within the past couple of days. I smoke and am on antidepressants. Have not been bothered by these symptoms until the last week or so

Symptoms:  Dizziness Heartburn
Doctor

A:   Hi.

Read and understood that for a week the symptoms are different than they were before. Also noted that the problem is intermittent, that you smoke and are on antidepressants and you feel lightheaded.
If I were to treat you, I would like to do EKG and cardiac check up first. And an upper GI endoscopy to rule out any serious matter.
This is very important point, rest of the treatment is symptomatic.
Please tell me the previous medications, reports and clinical presentation so that we can discuss treatment in details.

Awaiting for yours.

Comments / Follow Ups

Patient: 10mg melatonin
45mg mirtazapine
150mg hydroxyzine
1mg risperidone
10mg zolpidem
450mg Wellbutrin
Probiotic
12000mcg B12
Doctor: Thanks for your feedback.
I think these all together per day are too much of a dose you are taking.
Talk t your Doctor as no one really needs so many of the medicines of different classes that can really make one incapacitated.
I know you can do this.
I mentioned this here as so many medicines have all the great side effects, interaction- some known and some unknown.
Your present problem as I said should be investigated as mentioned above.
Additional treatment would be:
Take a PPI like Omeprazole
Liq Antacid 3 tsf every 3 hourly.
Soft bland diet, frequent feeds.
Adjust the doses of your existing medicines.
Investigations as already indicated above.

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