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

### input:
My mother is a 77 y/o women with diabetes and CAD. Several weeks  ago a full cardiac work up was done due to chest pains and irregular heart beat.  An implantable debrillator was placed on 4/15. Discharged from the hospital on 4/17/11.  Saw the MD and cardiologist on 5/2 and they said everything is fine. On 5/3 started having chest pains  went to the emergency room and was admitted.  What would can be causing chest pains if your cardiac enzymes and EKG are normal?

### output:

Hello, Sometimes, these things can be normal and still it can be cardiac pain, especially if it is occurring on exertion and relieving on rest. So if it is like this, she should have one echo and stress thallium test, in order to be more sure.  Also, I need to know more about the symptoms, like precipitating factors, factors that increase pain etc. Mostly it's a gastritis and reflux disease. Do you upper abdominal pain, nausea, bloating, burping, increase in pain on food, sour water feeling in throat or chest burning, if yes it further supports the diagnosis? You should avoid fatty, oily and high calorie diet. Have some walk after having food instead of taking rest. Have multiple small meals instead of heavy meals. Have regular sleep habits and avoid stress. Lots of green leafy vegetables, fruits. Avoid smoking and alcohol if any. You can get prescribed tab Pan DSR 40 mg before breakfast once a day for 2 weeks.  Secondly does this pain increase on applying pressure over the area, if yes it could be Costco Chat Doctor.  Does this pain increase on deep breathing and coughing etc. if yes it a pain arising from lining of lungs and needs NSAIDs treatment and evaluation.