A 45-year-old female with a known history of GERD presents with worsening heartburn, despite adhering to lifestyle modifications and daily proton pump inhibitor therapy. She also complains of chest pain that gets worse with deep breaths and lying flat. What could be the potential diagnosis, and what are the next steps?
While this patient's symptoms could be due to uncontrolled GERD, the new onset of chest pain that gets worse with deep breaths and lying flat raises concern for other conditions such as pericarditis or even cardiac ischemia. This patient should be evaluated further with an EKG and cardiac enzymes to rule out cardiac etiologies. If these tests are negative, other conditions like pericarditis or musculoskeletal chest pain could be considered. If her symptoms are eventually attributed to GERD, options such as increasing her PPI dose, adding a nighttime H2 blocker, or considering anti-reflux surgery could be discussed.