### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
History: I am a 60 yrs old. A duodenal ulcer was diagnosed about 25 years ago, but I have taken full course.I am patients of hyperacidity, which is being controlled by my diet. Four years ago I feel diziness, rapid heart beat, several times off & on and pain on left side chest. My angeogram was done and doctor told me that my heart and arteries are quite normal. There is no problem upto next 20 or 25 years. But my symptoms are still remain. Several times I feel stabbing pain in lateral part of my left side ribs shooting towards armpit with increase heart beat dizziness and confusion. A gland of my thigh was prominented.& examined, diagnosed tubercular. I am taking ATT from last 8 months regularly. But my symptoms of pain, rising from left lobe of liver to armpit is still stand occassionally with diziness and confusion. Sir I am eager to know that is it due to duodenal ulcer, heart disease, gas or gastric disease or due to ATT drugs ?

### output:

coronary angiogram is the gold standard test for diagnosis of coronary artery disease with a sensitivity level as high as 99.9% .so the chest pain and burning sensation is not because of cardiac cause. There are some other causes which can present with the same symptoms and can mimic pain of cardiac origin few of them are gastritis heart burn acid peptic disorders you say, you have acid reflux for several years, you were diagnosed with duodenal ulcer, ATT therapy also increases formation of acid and causes severe gastritis, most likely cause of your chest heaviness and pain is HERD(Castro esophageal reflux disease). Gastroesophageal reflux disease (HERD), Also known as acid reflux. HERD occurs when stomach contents move back into the throat. This may cause a burning sensation in the chest known as heartburn. Once cardiac condition has been excluded, the most common cause of chest pain is HERD. I would like to say that treatment of HERD is done according to the following guidelinesPatients are often prescribed a proton pump inhibitor (PPI) also called a PPI trial(e.g. omeprazole). They must be taken at least 30-60 minutes before breakfast. If the patient responds, the treatment can be continued for at least 8 weeks. For patients not responding to a PPI(as in your case) alone a combination of PPI with Levosulpiride should be tried for 4 weeks. Low doses from the class of Chat Doctor. These medications are felt to produce their favorable effect by reducing pain transmission from the esophagus to the brain. The two most commonly used agents are migraine and trazodone. For patients not responding to either acid inhibition trial or TCA, esophageal motility testing (a study done to evaluate the muscle contractions of the swallowing pipe) may be done to look for other uncommon causes of chest pain such as Andalusia. Esophageal Andalusia is an esophageal motility disorder involving the smooth muscle layer of the esophagus and the lower esophageal sphincter (LES), Andalusia is characterized by difficulty in swallowing, regurgitation, and sometimes severe chest pain and burning sensation. A peptic ulcer is one of the most important cause of dizziness, chest heaviness and explains all your symptoms.it's not your heart it's because of gastritis and ATT increases it