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

### input:
For over a week now Ive been having pain in my upper left chest above my breast when my heart starts to beat really fast. It usually happens when Im relaxed. My dr said my blood pressure was high in november 120 over 94 so he has me on Lisiniprol and also doubled my metformin dosage to 2000 mg per day. Are these symptons of a stroke or heart attack? Ive also been very bloated and gassy and the pain I have in my chest Ive had  for years. I just have never had such rapid heart beats and its causing me to freak out. Im due to go back to my Dr in feb. I also have shoulder pain but again, i have a bone spur there. The upper central part of my spine feels sore as well. I have a tons of issues going on in my life right now but I cant tell if its anxiety or truly heart attack/stroke related.

### output:

Hello! Welcome and thank you for asking on Chat Doctor! I carefully passed through your question and would explain that it is important performing a comprehensive differential diagnosis of different causes that may lead to these symptoms: - gastroesophageal reflux or hiatal hernia- a musculoskeletal pain, including Costco Chat Doctor.  - a backbone disorder - coronary artery disease, although the symptoms occurring at rest are not typical of this disorder-anxiety could mimic this clinical scenario I would recommend performing some tests: - a chest X-ray study- a resting ECG and cardiac ultrasound to examine your cardiac function and structure - an ambulatory 24-48 hours ECG monitoring to examine your heart rhythm through the day-some blood lab tests (complete blood count, PCR, sedimentation rate) for inflammation fibrogastroscopy may be necessary if all the above tests result normal, to help rule in/out possible gastroesophageal reflux. If all the above tests result normal, you should consider anxiety as the main cause of your symptoms. In such case you should consult with a specialist of the field. Hope to have been helpful! Best wishes, 