- Diseases, Disorders & Conditions
Heartburn – Is it a cardiac problem?
Heartburn or Heart attack
Many people and most of the doctors usually suspect a problem related to heart when a person reports of chest pain. The person is usually taken to the emergency room and tests are done to rule out problems related to heart. Many-a-times the person may just get lucky as he might be actually suffering from a less serious disease called “heartburn”. Despite its name, heartburn is actually a digestive problem that creates symptoms that are almost similar to that of the cardiac problems like angina and heart attack (myocardical infarction).
What actually is heartburn?
The food that we eat passes from the mouth to the small bag-like structure called the stomach through esophagus. The esophagus is a tube-like structure that is approximately 10 inches long and 1 inch wide in adults. The esophagus is narrowest at the top and bottom and also narrows slightly in the middle. The tissues and muscle layers of the esophagus expand and contract to propel the food to the stomach. This wave like movement of food is known as peristalsis.
At the lower end of the esophagus, where it joins the stomach, the esophagus bears a circular, muscular ring that seals the esophagus from the stomach. This ring is known as the lower esophageal sphincter (LES). After swallowing, the LES relaxes to allow food to enter the stomach and then contracts to prevent the back-up of food and acid into the esophagus. This sphincter normally remains opens when you swallow the food so that the food can enter into the stomach. The stomach produces various digestive enzymes and hydrochloric acid that help in the digestion of food. The stomach does not get affected by the acids because it is well protected by a thin layer of mucous lining. But the lining of esophagus cannot protect it from damage. That is why esophageal sphincter squeezes tight to prevent food and acid in the stomach from backing up into the esophagus. The LES also maintains a pressure barrier until food is swallowed again.
In some cases, either the LES opens too often or does not close tight enough causing the stomach acid to reflux, or seep, into the esophagus and cause the burning sensation. This unpleasant sensation that occurs when acid from the stomach rises up into the oesophagus (food pipe) and throat where it causes a burning pain is known as heartburn or more commonly acid reflux. Occasionally noticed heartburn is quite common. However, if it occurs quite frequently that is more than twice a week and if the symptoms are quite severe, it might be considered to be a hallmark symptom of Gastroesophageal reflux disease (GERD).
Why does heartburn produce symptoms that are almost similar to cardiac problems?
The esophagus and heart are located very close to each other and problems related to either one can cause chest pain. Due to this, many people mistake heart burn to be a heart attack or any other cardiac problem. A muscle spasm in the esophagus can also spread into the chest making one feel quite uncomfortable. So it is always better to seek the help of a medical practitioner in case of a pain in the chest area.
Some common symptoms noticed during heartburn and heart attack
Some common symptoms of heart burn
- A heart burn is usually noticed after having a heavy meal or when the person is bending or lying on his back.
- The person experiences a substernal pain or burning sensation in the upper chest area. This pain can gradually spread to the upper back and shoulders.
- Bitter taste in the mouth accompanied with a feeling of fullness.
- Persistent hiccups.
- Regurgitation of undigested or partially digested food.
- The symptoms of heartburn become worse after eating food, especially fatty, spicy or acidic food.
- These people face trouble in swallowing food.
- The person also experiences nausea/vomiting and abnormal flatulence.
- It also gives a sense of lump in the throat.
Some common symptoms of heart attack or angina
- A feeling of fullness, tightness, or dull pressure or pain, generally in the center of the chest. The pain is usually described as a squeezing or burning pain that gradually spreads to the shoulders, neck, arms, jaw, throat, or back.
- The person experiences shortness of breath and cold sweat.
- Nausea and possible vomiting is also observed in some cases.
- Excessive fatigue, dizziness and light headedness.
- A rapid or irregular pulse rate.
- People experience palpitations. They can actually feel their heart beat.
- Confusion and slurring of the speech as the tongue doesn’t work properly on one side.
How can you differentiate between heart attack and heartburn?
Even though the symptoms of heartburn and heart attack are quite similar, there are some striking differences that would help to differentiate one from another.
Nature of pain
Heart attack usually arises when the blood supply to the heart is obstructed. These people experience a squeezing or crushing sensation in the chest region. They feel as if some heavy weighted object has been placed on their chest. This pain is generally experienced throughout the chest so it is difficult to pinpoint the pain. It may also radiate to the shoulder, one or both arms, back, neck, jaw, or stomach.
The heartburn, on the other hand, arises when the acidic content of the stomach travel back into the esophagus. These people complain of sharp and stabbing pain and do not experience a pressure on the chest. In these people, the pain generally begins in the lower chest or upper abdomen and may reach to the lower throat.
Relief from the pain
Rest or use of some drugs that relax the blood vessels like nitroglycerin, can provide some comfort to angina patients. However, if the .person is suffering from heart attack, they cannot be of a major help as they would require quick medical attention.
A person suffering from heartburn complains of the worsening of the pain when he is asked to lie down or when he bends over. Moreover, this pain usually crops up after meals. These people respond well to antacids.
Duration of pain
Pain arising from angina usually lasts only for five to fifteen minutes and pain due to heart attack generally lasts for 20 minutes or more. This pain is not constant as it comes and goes away. On the other hand, the pain due to heartburn can last for hours to days.
Nausea and shortness of breath
Nausea is the most common symptom of heart attack. It is usually accompanied with vomiting in these patients. Nausea is less commonly noticed in patients suffering from heartburn. They often feel as if the food has come back into the mouth and complain of acidic or bitter taste in the throat region.
Shortness of breath is commonly noticed in heart attack patients. The incidences of heart attack are more after exercise. On the other hand, the heartburn patient rarely complains of the need of air. He might take short breaths but that is because he experiences pain during inhalation.
Experience of cold sweat, lightheadedness, or dizziness
Cold sweat, lightheadedness and dizziness are the common symptoms of heart attack. The skin often turns pale, blue, or gray due to the insufficiency of oxygen rich blood. These symptoms are not usually observed in case of heart burn patients.
How is heartburn diagnosed?
On the basis of the contrasting symptoms described above, a medical practitioner can differentiate between the two conditions. However, in some cases, the symptoms are not so clear and deciding. In such cases, the physician usually relies on certain medical tests to diagnose heartburn and to rule out a heart attack. Some of these tests are:
- A barium swallow – This test is usually suggested when an individual has difficulty or pain in swallowing. The patient is asked to drink a solution containing barium. Then an x-ray of the digestive tract is taken. This x-ray helps in identifying structural abnormalities and erosive esophagitis. However, it cannot reveal mild irritation.
- Cardiac evaluation – Tests like ECG are done to assess the condition of the heart.
- Upper endoscopy – During this procedure, a thin, flexible fiber-optic tube containing a tiny camera is inserted into the esophagus through the patient’s mouth. The camera traverses through the esophagus, stomach and provides a clear picture of upper part of the digestive tract. Disturbances in the lining of the esophagus can be easily observed through this test.
- Esophageal pH monitoring – This test is conducted using electrodes that measure the pH (acid level) in the esophagus. It helps in the determination of the acid backup. This test is usually done over a 24-hour period. This test is particularly useful when disturbances in the mucus lining of the esophagus remain undetected through endoscopy but the patient continues to exhibit the symptoms of heartburn.
- Esophageal manometry or motility studies – This technique is useful to measure the muscular pressure. It helps to measure the squeezing motion of the esophagus when one is swallowing food. A tube containing various openings is placed through the esophagus. When the muscles of the esophagus contract they put pressure on the tube at various locations. The tube is externally connected to a computer which measures these pressure differences.
Can we prevent heartburn?
Even though heartburn is painful, the best part is that it responds well to the changes in the dietary and lifestyle habits. If heartburn is neither too frequent nor too intense, modifications in our habits might help us to get relieved and also to avoid the trip to a pharmacist. Some of these modifications include –
- Timing of meals – We should not leave the stomach empty for a very long duration of time as it helps in building up acid. Dinner should be light and should always be taken 2-3 hours before bedtime. This is because food gets sufficient time to get digested.
- Nature of meals – Avoid taking junk food, fried foods, etc that contain high content of fats as fats take a longer time to get digested. Foods and beverages that contain caffeine, chocolate, garlic, onions should also be avoided as they stimulate the acid secretion. Acidic foods including citrus fruits and tomatoes should be avoided.
- Carbonated beverages – They should be avoided as burps of gas force the esophageal sphincter to open and can promote reflux.
- Clothing – Tight fitting clothes should be avoided as tight fitting around the abdomen slows down the digestion.
- Weight reduction – People who are overweight are at a greater risk of succumbing to heart burn. So it is better to go for a morning walk as it improves the metabolism.
- Nighttime heartburns – Many people experience an acid reflux during bed time making them uncomfortable. They people can try a walk after dinned and strictly avoid bed time snacks. Sometimes, even staying upright also helps, as gravity pulls the acids down into the stomach. While sleeping, try to elevate the head of your bed by 10 to 15 centimeters with the help of large wooden blocks. This tilt in your sleeping posture would help your acid to stay in stomach. Try to sleep towards the left side, as this would allow the fluids of the stomach to pool away from the lower esophageal sphincter (LES) and stay within the stomach.
- Smoking and alcohol consumption should be strictly avoided.
Some natural home remedies for heartburn
For many problems, natural home remedies do wonders. They are like doctors at home. But in many cases, we are unaware about them. One can try some of these natural remedies to get rid of the heartburn –
- Fresh ginger juice - Add one teaspoon of freshly grated ginger to one cup of boiling water and allow it to settle down for a few minutes. This ginger tea can be consumed several times a day. The ginger juice absorbs acid in the stomach and helps calm the nerves that contribute to heartburn. So it provides a two-way relief!
- Mint juice - Add one tablespoon of crushed mint leaves to a cup of water and keep it aside for half an hour. Drink this juice for two to three times a day. Mint aids in digestion and has soothing properties and thus helps to relieve heart burn.
- Baking soda – Chemically, baking soda is sodium bicarbonate. It acts as a natural antacid that provides instant relief due to its basic properties. Just one tea spoon of baking soda has to be mixed in a glassful of water and consumed.
- Aloe vera juice - Drink two ounces of unprocessed aloe vera juice daily. This controls heartburn by reducing inflammation and healing the gastrointestinal tract.
- Chewing gum – People are asked to chew sugar-free gum for about half an hour after a meal as this would stimulate the salivary glands to increase the flow of saliva. The saliva is basic in nature and thus neutralizes stomach acid giving instant relief from heartburn.
- Consume fruits like apples and bananas – They create an alkaline environment in the stomach and this neutralizes the excess of acids created. It is better to consume these fruits a couple of hours before bed time.
- Consume raw almonds – They produce an alkaline environment and balance the pH of the stomach. Of course one should not over-eat them as it would trigger other problems. They are calorie rich foods so it is better to chew only 3-4 almonds per day.
So try these natural remedies and stay away from heart burn!
Try each in moderation and see what best suits you.