Is it heart­burn or a heart at­tack?

The Hamilton Spectator - - HEALTH -

Dear Mayo Clinic: My dad re­cently went to the emer­gency room with ter­ri­ble chest pain and sweat­ing, and was con­cerned he was hav­ing a heart at­tack. He was kept overnight for mon­i­tor­ing, but doc­tors said his heart was fine and that his symp­toms were prob­a­bly due to heart­burn. Should I sug­gest he have more tests to de­ter­mine if it’s some­thing more se­ri­ous? Are there things he can do to avoid hav­ing an­other episode like this?

A: In a sit­u­a­tion like this, it’s im­por­tant for your fa­ther to have a fol­lowup ap­point­ment with his pri­mary care physi­cian to con­firm the un­der­ly­ing cause of his symp­toms. The physi­cian can do a more thor­ough eval­u­a­tion, and re­fer him for more tests and a con­sul­ta­tion with a car­di­ol­o­gist, if needed.

Heart­burn, a burn­ing sen­sa­tion un­der the breast­bone, is a symp­tom of gas­troe­sophageal re­flux dis­ease, or GERD. It hap­pens when stom­ach acid backs up into the esoph­a­gus — the tube that car­ries food from your mouth to your stom­ach. Al­though a burn­ing sen­sa­tion in the chest is com­mon with GERD, its symp­toms can vary widely. In some cases, GERD may feel like a dull ache or pres­sure in the chest, or, if it’s se­vere, GERD can lead to crush­ing chest pain. A heart at­tack, heart dis­ease and other car­diac con­cerns can trig­ger sim­i­lar symp­toms.

Dis­tin­guish­ing the dif­fer­ence be­tween the symp­toms of GERD and those that could be re­lated to a heart con­di­tion can be dif­fi­cult. That’s be­cause the nerves that lead to the heart and those that lead to the esoph­a­gus are lo­cated close to one an­other, so de­ter­min­ing ex­actly where symp­toms come from can be a chal­lenge.

With that in mind, it’s im­por­tant to con­firm that chest pain is not heart-re­lated. So, even if re­sults of heart tests such as an elec­tro­car­dio­gram look fine in the emer­gency care set­ting, a more com­pre­hen­sive eval­u­a­tion still is needed. In many cases, that as­sess­ment in­cludes a stress test to see how well the heart works dur­ing phys­i­cal ac­tiv­ity. Based on the sever­ity of his symp­toms and your fa­ther’s med­i­cal his­tory, his physi­cian can de­ter­mine if he needs to see a car­di­ol­o­gist for ad­di­tional test­ing.

It is pos­si­ble that an­other con­di­tion un­re­lated to GERD or a heart con­di­tion could be caus­ing your fa­ther’s symp­toms, such as gall­stones. In most cases, how­ever, chest pain comes from a car­diac con­cern or GERD.

If the fol­lowup as­sess­ment shows that your fa­ther’s symp­toms are due to GERD, there are a num­ber of steps he can take to help pre­vent symp­toms in the fu­ture. Overeat­ing or eat­ing a large meal and then ly­ing down are the two most com­mon heart­burn trig­gers. Eat­ing smaller meals and not eat­ing two to three hours be­fore go­ing to bed of­ten can re­duce symp­toms. Avoid­ing high­fat foods, spicy foods and citrus juices can be help­ful, too. Many peo­ple who ex­pe­ri­ence heart­burn also find that re­duc­ing al­co­hol, caf­feine and nico­tine may de­crease the fre­quency of symp­toms.

Typ­i­cally, GERD does not re­quire med­i­cal treat­ment. Over-the­counter antacid med­i­ca­tions are of­ten enough to de­crease symp­toms, along with lifestyle changes. Some symp­toms, how­ever, should prompt a med­i­cal ap­point­ment, in­clud­ing food stick­ing in the esoph­a­gus, dark or bloody stools, un­ex­plained weight loss or bouts of heart­burn that hap­pen more than two or three times a week.

The bot­tom line is that your fa­ther needs fur­ther eval­u­a­tion to make sure he doesn’t have a heart con­di­tion. GERD can be man­aged, and no­body dies from it. But un­treated heart prob­lems can be fa­tal. It’s im­per­a­tive your fa­ther have a for­mal car­diac eval­u­a­tion at this time.

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