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

### input:
I have pressure in the middle of my chest that is mildly painful, very unsettling along with a little dizziness, which Im prone too anyway.  I can feel my heart pounding in my chest too.  It started about 3 am last night and lasted about 10 minutes or so then again for about 20 minutes.  This went on til 4am.  I felt pretty good today, tired but better. Then at 6pm the chest pressure and pain returned.  Now at 11:30 its still bothering me.  Im not in severe pain.  Its more worrisome than anything else.  What is it?

### output:

Hello! Welcome on Chat Doctor! I understand your concern and would explain that it is important performing a careful differential diagnosis of different causes that may mimic this symptomatology: - Myocardial ischemia. A resting ECG and cardiac enzymes are necessary to be done to exclude this possibility.- Musculoskeletal pain. Do your symptoms worsen during breathing or body movements? This would indicate possible musculoskeletal pain. Inflammation tests (PCR, sedimentation rate) should be done. - A lung disorder. A chest X-ray study is needed in this clinical situation. - Anxiety could also mimic all this clinical situation.- Gastroesophageal reflux. Have you tried taking antacids during these episodes? The pain relief from antacids could indicate possible HERD or gastritis. You should discuss with your doctor on the above possibilities and tests. If all the above tests result normal, you should consider anxiety as the main cause of this symptomatology. Hope you will find this answer helpful! Kind regards, 