Why do heartburn and chest pain occur?

A person who experiences chest pain should seek medical help immediately, especially if the pain is unexplained, sudden, and/or severe.

A heart attack occurs when one of the arteries that supplies blood to the heart becomes blocked or narrowed.

Heartburn also causes a burning pain that is felt in the upper abdomen or lower chest. Heartburn is caused by stomach acid that moves up the esophagus. The symptoms of heartburn and heart attack can be similar.

Symptoms of myocardial infarction

Myocardial infarction often, but not always, has the classic symptoms:

Chest pain that is often described as tightness or heaviness.

The pain may come and go, but lasts more than a few minutes.

Myocardial infarction does not always produce the same symptoms. They can be mild or severe, and some people experience no symptoms at all.

The pain or discomfort is usually located in the central or left side of the chest. The pain may spread to one or both arms, neck, jaw, upper and/or middle back.

Myocardial infarction is often accompanied by other symptoms:

Cold sweat;

Dyspnea;

Nausea and vomiting;

Feeling very tired;

Dizziness.

Symptoms may not appear in older people or in people with diabetes.

"An upset stomach can be a sign of heart disease in people with diabetes," says Ahmed Idris.

Fire in the chest, or How to cure heartburn

Have you ever experienced a burning sensation or acute discomfort in the chest area or along the esophagus after eating or exercising? Often this ailment is combined with belching, especially sour ones. If you are familiar with such symptoms, then you are convinced from your own experience that heartburn is a very unpleasant ailment. Moreover, not only you were convinced of this. Recent studies in Russia have shown that approximately 60% of the country's population suffers from heartburn, which, after all, is almost 87 million people.

Heartburn is one of the most common complaints that a practitioner has to deal with. It makes itself felt 30-45 minutes after eating as a result of the reflux of acidic stomach contents into the esophagus, but occasionally on an empty stomach. Most often, the disease affects people with high acidity of gastric juice. And then, in the question of how to cure heartburn, therapy for this particular condition should take first place.

The causes of heartburn are very diverse:

organic acids formed in the stomach during digestive disorders
irritation of the esophagus with bile thrown from the gallbladder into the duodenum, then into the stomach and esophagus
development of inflammatory processes in the upper gastrointestinal tract
chronic gastritis, duodenitis, erosive and ulcerative lesions of the stomach and duodenum
chronic cholecystitis
functional disorders of the biliary system

So, the feeling of heartburn appears due to the reflux of acidic stomach contents into the lower parts of the esophagus. Normally, a muscular sphincter is located between the esophagus and the stomach, which, by contracting, prevents gastric contents from flowing back into the esophagus. If a kind of “valve” closes incorrectly or at the wrong time, the acid enters the esophagus and begins to affect its mucous membrane. In addition to hydrochloric acid itself, pepsin, bile acids, lysolecithin and pancreatic enzymes also play a special damaging role in the process.

In approximately 75% of cases, heartburn is the main symptom of gastroesophageal reflux disease (GERD), a chronic disease associated with spontaneous, regularly repeated reflux of gastric contents into the esophagus, causing damage to the mucosa. However, sometimes heartburn bothers practically healthy people. In such a situation, malaise is a consequence of poor nutrition, that is, abuse of spicy seasonings, fatty foods, and alcoholic beverages. For some people, sour fruits (apples, lemons, plums), kefir and other lactic acid products, and black bread also cause discomfort. In addition, drinking carbonated water, strong tea or coffee is very “dangerous” in terms of the risk of causing heartburn. A bad habit like smoking also increases your chances of being killed by your own stomach.

It should be said that heartburn almost always bothers pregnant women. The causes in this case are toxicosis and vomiting, and, consequently, irritation of the esophagus. Temporary functional insufficiency of the cardiac part of the stomach in the second half of pregnancy also contributes to the development of the disease. The growing uterus leads to an increase in intra-abdominal pressure, as a result of which the cardiac sphincter does not close tightly enough and the contents of the stomach are thrown back into the esophagus.

If you experience heartburn attacks irregularly, only occasionally bothering you after eating, then you shouldn’t worry too much, but you need to reconsider your diet and understand what exactly provokes the malaise. If the disease is constantly present in your life, systematically causing inconvenience, you should consult a doctor as soon as possible, who will tell you how to cure heartburn. It is quite capable of being a symptom of gastritis or ulcers of the stomach and duodenum.

Differences between heartburn and heart attack symptoms

Sometimes it can be difficult to differentiate whether chest pain is caused by a heart attack or heartburn.

A Harvard doctor, for example, told his story of heart disease. He had a burning sensation in his upper abdomen; treatment for heartburn did not help. When he began to choke, they called an ambulance. It turns out he had a myocardial infarction.

Main differences between symptoms:

Heartburn tends to worsen after eating and when a person lies down. Although a heart attack can also occur after eating;

Heartburn goes away after taking medications that reduce the level of acidity in the stomach;

Heartburn does not cause common symptoms such as shortness of breath;

A heart attack does not cause bloating or belching.

Why do heartburn and chest pain occur?

What can cause painful swallowing and periodic chest pain?

Gennady Sergeevich, Volkovysk
If these symptoms occur, you should consult a doctor. Most often they indicate esophagitis - acute or chronic inflammation of the esophagus. There are many reasons for its occurrence.

Acute esophagitis can be associated with chemical and temperature burns, damage by the herpes virus and others, foreign bodies (poultry or fish bones, coins, buttons and even dentures) or large pieces of unchewed food. Chronic esophagitis is often associated with gastroesophageal reflux, that is, the reflux of stomach contents into the esophagus. This leads to damage to the esophageal mucosa.

This can happen in a completely healthy person, but not more than once or twice a day after meals. The onset of the disease is accelerated by excess weight, dietary errors, in particular, excessive consumption of fried and spicy foods, alcohol abuse, as well as gastritis, hiatal hernia, diseases that occur after gastric surgery, cholecystitis, pancreatitis, cholelithiasis and much more.

Treatment of myocardial infarction

If you suspect a myocardial infarction, you should call emergency services. Doctors will study the symptoms and examine the patient.

Research methods for suspected myocardial infarction:

ECG (electrocardiogram) - measurement of heart rhythm and electrical activity;

Echocardiography - studies the heart using ultrasound;

X-rays, blood tests and angiography;

Cardiac catheterization is one form of treatment. The doctor can mechanically open the narrowed arteries. A thin, flexible tube runs along the blood vessel to the area that is blocked or narrowed. A balloon is used to widen the artery, which improves blood flow. A tube known as a stent may be left in place to keep the vessel open.

Another treatment option for a heart attack is fibrinolytic or thrombolytic drugs. These drugs dissolve the clot while the patient waits for a cardiac catheterization. Other drugs may be suggested to prevent blood clotting, including aspirin and heparin.

Surgery options may include grafting a new blood vessel taken from another part of the body to bypass the blocked coronary artery.

People who have had a heart attack are advised to take long-term efforts to reduce the risk of future problems. This could be lifestyle changes, ranging from diet to exercise. Smokers should stop using tobacco.

Clinical manifestations

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Although GERD is one of the most common gastrointestinal diseases today, there is no consensus on how to describe the typical presentation of GERD. This is due to the fact that the disease manifests itself in various symptoms and there is no universal definition of this disease. GERD could be defined as a syndrome or clinical condition characterized by damage to the lining of the esophagus by gastric juices. However, such a definition is sufficient only in the case of GERD, accompanied by the development of reflux esophagitis, which is not always the case. Testing acid levels in a clinic can help identify pathological acid reflux, but the sensitivity of the esophageal mucosa to acid varies from person to person. Therefore, to determine the disease, it is important that patients have a set of certain symptoms.

Typical symptoms

Most often, patients with GERD complain of heartburn , sour belching and dysphagia (difficulty swallowing).

Heartburn is a feeling of discomfort or burning behind the sternum, spreading upward from the epigastric (epigastric) region, sometimes radiating to the neck area. Heartburn appears periodically, most often an hour after eating, during physical activity, when tilting the body or in a horizontal position. Usually, to relieve (stop) heartburn, it is enough to drink water; you can stop heartburn by taking antacids (substances that neutralize the effect of acid). However, attacks of heartburn can recur quite often and disrupt a normal lifestyle. Heartburn that occurs more than three times a week significantly impairs the quality of life. Although there is some relationship between the incidence of heartburn, the duration of esophageal clearance and the presence or absence of damage to the esophageal mucosa, this relationship is not clear-cut. Some patients with severe esophagitis, and even those with Barrett's esophagus, may not complain of heartburn .

Causes of heartburn:

Consumption of certain foods and drinks reduces the tone of the lower esophageal sphincter. These include: chocolate, products containing peppermint, fatty foods, alcohol and caffeine-containing drinks (coffee, black tea, Coca-Cola, etc.).
Heartburn sometimes occurs in certain body positions: when bending over and in a horizontal position (when you lie or sleep).
Heartburn can be caused by any condition in which there is an increase in pressure in the abdominal cavity, which contributes to the backflow of gastric juice and food masses from the stomach into the esophagus: physical strain, heavy lifting, coughing, tight clothing, obesity and pregnancy (due to an enlarged uterus).
Concomitant diseases can contribute to the appearance of heartburn: hiatal hernia, diabetes, autoimmune diseases (rarely encountered: Raynaud's syndrome, scleroderma, etc.).
The use of certain medications leads to dysfunction of the lower esophageal sphincter: some drugs to lower blood pressure, heart medications, as well as drugs for the treatment of bronchial asthma containing theophylline (Teopek, Theotard, etc.).
Many substances can irritate the lining of the esophagus, contributing to heartburn: spicy foods, citrus fruits and juices, tomatoes and tomato sauces, cigarette smoke, aspirin, ibuprofen and medications for the treatment of osteoporosis.

Symptoms and complications

Heartburn is a burning sensation behind the breastbone. This sensation can occur in the epigastric region and spread upward, as well as into the throat, jaw, arms or back. This sensation is very similar to the pain experienced during a heart attack. Therefore, if you experience severe chest pain (especially for the first time, when you still cannot accurately determine from the sensations that it is heartburn), you should immediately consult a doctor.

Heartburn usually occurs

reduce the feeling of heartburn by changing your body position (standing up), swallowing saliva or drinking water, as well as taking antacids (Maalox, Almagel, a simple baking soda solution helps many).

Regurgitation . Occurs when a small amount of gastric juice enters (passively flows) into the mouth, resulting in a bitter or sour taste in the mouth. Most often, regurgitation appears after eating in a lying position (including during sleep), when tilting the body or straining. Frequent exposure to acid in the mouth can cause damage to tooth enamel.
During regurgitation, gastric juice can also enter the respiratory tract, which can cause bronchial asthma, hoarseness, persistent cough, and sore throat. This may cause a sensation of a lump in the throat.
When acid is exposed to the lining of the esophagus for a long time, it can cause serious damage. In this case, difficulty swallowing (dysphagia) may occur, and in severe cases, loss of weight and fluid in the body (this is also due to the fact that the person tries to avoid eating too much, as this causes an attack of heartburn and difficulty swallowing). In rare cases, the esophagus may be damaged to such an extent that bleeding may occur. Then vomiting with blood or blood-stained stool appears (looks like black, tarry).

Treatment for heartburn is usually the same as for reflux disease, since heartburn is most often caused by the presence of this particular disease. For recommendations on lifestyle and nutritional changes, see also this section.

GERD – When is it necessary to see a doctor urgently?

If heartburn attacks recur despite lifestyle changes and the use of antacids; and also if heartburn occurs more than three times a week over the past 2 weeks.

In the following cases, immediate medical attention is required (call an ambulance):

Vomiting blood or dark, tarry stools.
When sharp, intense chest pain occurs, accompanied by dizziness or impaired consciousness.
Difficulty swallowing.
Dehydration (determined by symptoms: decreased elasticity and dry skin, dry mouth, pointed facial features).
Unreasonable weight loss.

Regurgitation is the passive flow of esophageal or stomach contents into the pharynx, not accompanied by nausea or vomiting. Patients note that acidic or burning liquid, sometimes with the remains of undigested food, gets into the throat or mouth. Belching, bending over, or any movement that increases intra-abdominal pressure can trigger regurgitation.

Up to 30% of people with GERD may experience dysphagia. The occurrence of this symptom can be provoked by strictures of the esophagus, impaired peristalsis, inflammation of the mucous membrane of the esophagus, and dysphagia can also appear after surgery on the esophagus. Sometimes dysphagia appears for no apparent reason, which can be explained by the presence of an individual reaction to certain muscle contractions during esophageal peristalsis.

Other less common symptoms include a feeling of increased saliva in the mouth, a feeling of a lump in the throat, and odynophagia (pain when food or liquid passes down the esophagus).

The feeling of increased saliva in the mouth is the result of a reflex associated with the vagus nerve, which occurs due to the effect of acid on the mucous membrane of the esophagus.

The sensation of a lump in the throat is a feeling of a foreign body in the throat that occurs regardless of the act of swallowing.

Odynophagia more often occurs in the presence of esophagitis that has developed as a result of taking medications or infection, therefore, in the presence of odynophagia, the diagnosis of reflux esophagitis requires additional confirmation. If odynophagia appears in a patient with GERD, then, as a rule, this indicates the presence of an esophageal ulcer or deep erosion.

Atypical (rare) symptoms

Laryngitis . In 1968, it was first discovered that pathological reflux can cause damage to the mucous membrane of the larynx and may be accompanied by prolonged hoarseness, redness and swelling of the larynx, ulceration of the vocal cords and the formation of nodules on them. From 4% to 10% of patients with reflux disease turn to an otolaryngologist (ENT doctor) with characteristic complaints, and laryngitis occurs twice as often in patients suffering from esophagitis. Studies involving repeated acid measurements have shown that laryngitis due to GERD is caused by acid reflux into the upper esophagus and subsequent acid reflux into the larynx.

Bronchial asthma . Back in 1892, it was suggested that GERD was related to bronchial asthma, based on observations when patients with overdistension of the stomach heard wheezing in the lungs. Subsequently, this hypothesis was confirmed by research. Symptoms of GERD are observed in 80% of patients with bronchial asthma. Although it was subsequently discovered that acid reflux into the esophagus has only a minor effect on lung function, treatment of GERD helps to reduce asthma symptoms in such patients.

Cough . Chronic cough occurs in many diseases, but 80-90% of cases occur in bronchial asthma, GERD and a disease in which there is a constant release of mucus from the nose, flowing into the throat and causing irritation. With GERD, chronic cough occurs in 10-40% of cases, and may be the only symptom, which makes diagnosis difficult. According to research, the occurrence of cough with GERD may be associated with acid irritation of the nerve endings in the esophagus, which increases the activity of the cough center in the brain - a reflex occurs.

Chest pain not associated with heart disease. In almost 30% of patients who undergo a study of the heart vessels for complaints of chest pain, the heart vessels turn out to be normal. After the presence of heart disease is excluded in such patients, an examination of the esophagus is performed. These chest pains were initially thought to be caused by esophageal dysmotility, such as widespread esophageal muscle spasm or nutcracker syndrome. However, manometry showed that chest pain had little connection with impaired contractile activity of the esophagus. At the same time, measuring acidity in patients with complaints of chest pain in the absence of heart disease confirmed the presence of increased acidity in the esophagus. These data suggested that chest pain not associated with heart disease was due to reflux. The mechanism of occurrence of these pains remains unclear.

So, the main symptoms

Heartburn.
Chest pain lasting more than 2 hours.
Heartburn tends to get worse after eating.
Lying down or wearing tight clothing can trigger or worsen heartburn.
The appearance of pain or its intensification has nothing to do with physical activity.
Not all patients with GERD experience heartburn.

Other symptoms:

Regurgitation, which occurs more often during sleep or bending over.
Unpleasant taste in the mouth.
Constant dry cough.
Hoarseness of voice.
Feeling of a lump in the throat.
Attacks of difficult noisy breathing.

The most common symptoms in children:

Repeated vomiting.
Cough.
Difficulty breathing, asthma attacks, pneumonia.

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Diagnosing heartburn

The doctor makes a diagnosis based on symptoms.

He should ask when, how often and for how long they occur, and how the problem changes and responds to nutrition, how symptoms respond to stomach acid suppression treatments.

Possible imaging of the esophagus—Doctors may use an endoscope to see any damage to the lining of the esophagus.

Performing esophageal pH testing to measure acidity levels

Doctors prescribe treatment that can confirm the diagnosis.