December 1st, 2020 12:00am
Have you ever had an uncomfortable feeling in your chest and wondered if this could be “the big one”? Before I go any further, please consider the following: don’t read this blog and make your own diagnosis. If you question whether you are having a heart attack, stop reading and immediately call 911.
Okay, now that’s out of the way, let’s continue. The esophagus is the “pipe” that goes from the back of the throat, through the chest (running in the back of the heart), and into the stomach, after passing through the diaphragm (which separates the chest from the stomach). Once food passes from our mouths, through the esophagus, and into the stomach, a “door” is supposed to shut, keeping the contents of the stomach from regurgitating back into the chest portion of the esophagus. Unfortunately, that door can become defective so that it does not close all the way. That’s when heartburn occurs, or its other commonly known description gastroesophageal reflux disease (GERD). I dislike qualifying this as a disease because most people, indeed Americans, have this condition, yours truly included!
Although digestion of our food starts in the mouth with chewing and some enzymes, the central part of digestion begins in the stomach. That is why the stomach environment is very acidic—it’s supposed to be. But that acid is supposed to stay in the stomach, not drift up into the esophagus. When it does, it does what most acid does—dissolves things. That sounds pretty toxic, and it is, in a way. It doesn’t belong in the esophagus, and the higher it travels up, the more areas are affected by it. Acid is corrosive, and it does that to tissues in the body that are not prepared to be exposed to it. The stomach has special cells to protect it, but the esophagus does not.
It seems impossible for substances to travel through, even a partially closed door, and upwards in the body. Isn’t gravity intended to prevent that? Figure this, though. The stomach is moving around a lot once the food is in it. As it is churned or stuffed to the brim, it can force the “door” open a bit; acid can seep out and up, causing a burning discomfort or pain. While laying flat, if the door is open even a little, acid can seep into the chest and even into the throat.
All this is important because the regurgitation of acid upward can cause acute or chronic pain and be misconstrued as other ailments, for instance, heart pain, or a heart attack. Telling the difference between the two is crucial. Here are six key differences (Please note: as I stated above, do not use this blog as your definitive guide. If you have any questions, you must contact your doctor and/or call 911). These are the more common presentations. Variations always are possible.
Heartburn usually lasts hours. Angina is the name for chest pain associated with partially obstructed heart blood vessels. It typically lasts only 5 – 10 minutes. Anything longer may indicate a complete blockage and is a medical emergency.
Quality of pain
Heartburn is more of a discomfort and annoying. Heart attack pain can be that way as well but is usually much more severe and is sometimes described as “an elephant sitting on my chest.”
Character of the pain
Heartburn is usually just that, a burning discomfort. Over time, the acid can erode the esophagus’ lining and cause more of an aching pain. It can also cause the esophagus to spasm, which can be described as a squeezing pain. Heart attack pain has been described as pressure, tightness, or squeezing.
Location of the pain
Heartburn pain is usually along the path from the stomach upward through the esophagus; essentially, if you were to draw a line just under the chest bone to your throat. Heart attack pain is known to radiate to the jaw, shoulders, and down the arms. The lower area of the heart sits close to the diaphragm, and therefore in the place where the esophagus passes through on its way to the stomach. Therefore, if a blood vessel occluded in that area of the heart, it may irritate some of the same nerves and lead to a fullness sensation, nausea, and even be described as heartburn.
Relief of Pain
Heartburn, at least initially, can be relieved by taking something that neutralizes the acid. Popular brands with a rapid onset of doing that include Tums, Rolaids, Mylanta, and Pepcid Complete. Heart attack pain, usually, would not be affected by these medications. Dissolving a nitroglycerine tablet under the tongue usually can relieve angina, which may precede a heart attack. Still, once one is experiencing a heart attack, there is not much to do at home to ease the pain. (Just a note—nitroglycerine can sometimes relieve esophageal spasm making the distinction between the two types of pain more difficult).
Heartburn can sometimes cause nausea and vomiting. Heart attacks can also lead to nausea and vomiting. They are frequently accompanied by shortness of breath and a cold sweat, which would be atypical of heartburn.
Knowing the difference between heartburn and a heart attack may be critical to your survival. You must never minimize symptoms and try to diagnose yourself. These descriptions can serve as a guide but should not replace your doctor. My Patreon video will show you practical and more natural ways of dealing with it if you suffer from heartburn.
© Dr. Charles F. Glassman, CoachMD