Chest Discomfort: Is It Esophageal or Cardiac?

Q: Chest Discomfort: Is It Esophageal or Cardiac?

Dear Ms. <br>Helen：<br>1. <br>After food passes through the pharynx, it enters the esophagus, which is a long tubular structure approximately 25 to 30 centimeters in length. <br>It is located behind the trachea and extends from the pharynx through the neck and chest, passing thro

Mild chest pain?

Hello, Doctor: Last weekend, I had a cold and visited a clinic where the doctor prescribed me cold medication.
However, after taking the nighttime medication on Sunday, I experienced a sensation of chest pain the next day.
It is especially noticeable during lunch and dinner, and I also feel a slight pain when I burp, but it subsides after eating or after some time has passed since eating.
Yesterday, I returned to the clinic and asked the doctor about it.
He mentioned that I might have irritated my esophagus and advised me to avoid spicy foods and to rest.
But isn't the esophagus located in the throat? How could it cause chest pain? Additionally, I've been worried after seeing recent news about arterial dissection and sudden death, and I'm concerned that this might be related to my heart or lungs.
The clinic doctor told me not to scare myself; he said that heart issues would cause significant pain and that my lungs sounded fine, especially since I haven't been coughing.
However, I'm still feeling anxious, so I wanted to consult with a doctor.
Also, if the pain is indeed caused by the esophagus, how long does it typically take to recover? It's been 3-4 days already, and I forgot to ask yesterday, but my mom said thank you for your response! She mentioned that he had a similar experience after swallowing an anti-inflammatory pill.

Helen, 20~29 year old female. Ask Date: 2021/08/26

Dr. Xiao Yongxun reply Family Medicine

Dear Ms.
Helen:
1.
After food passes through the pharynx, it enters the esophagus, which is a long tubular structure approximately 25 to 30 centimeters in length.
It is located behind the trachea and extends from the pharynx through the neck and chest, passing through the diaphragm to reach the stomach.
Its primary function is to transport the swallowed bolus to the stomach.
As the bolus passes through the upper esophagus, the muscular layers of the esophagus facilitate its movement through peristalsis and the secretion of mucus, allowing the bolus to reach the stomach even when a person is inverted.
However, the esophagus does not secrete digestive enzymes and does not have absorptive functions.
2.
The stomach is the expanded portion of the digestive tract, located in the upper left abdomen and beneath the diaphragm.
It connects to the esophagus at the cardia and to the small intestine at the pylorus, with a total capacity of approximately 1,000 to 3,000 milliliters.
The primary functions of the stomach are to temporarily store and digest food.
The bolus entering the stomach undergoes physical and chemical digestion, forming chyme, which is then sent to the duodenum, the first part of the small intestine, for further digestion.
The stomach typically absorbs only simple molecules such as water, alcohol, and medications.
Excessive consumption of alcohol or medications can damage the gastric mucosa, leading to gastric bleeding.
3.
Therefore, the esophagus begins at the larynx, and during swallowing, the epiglottis covers the trachea to direct food into the esophagus, preventing choking.
Acidic substances from the stomach can reflux into the esophagus for various reasons (such as relaxation of the lower esophageal sphincter, sliding hiatal hernia, etc.), causing damage to the esophageal mucosa, a condition known as reflux esophagitis.
Esophagitis can also be caused by infections, alcohol consumption, smoking, caustic injuries from strong acids or bases, radiation damage, and excessively hot foods and beverages.
The main clinical symptoms include dysphagia and heartburn.
Major complications include bleeding, esophageal stricture, or the development of Barrett’s esophagus due to chronic reflux.
Clinically, a small number of patients may experience pill esophagitis due to taking pain medications (non-steroidal anti-inflammatory drugs) or certain antibiotics (such as tetracycline) without sufficient water, leading to the medication remaining in the esophagus and causing symptoms like chest pain and dysphagia.
Additionally, some patients who regularly experience gastric pain or consume coffee, tea, milk tea, or alcoholic beverages may develop upper abdominal pain or chest pain after taking pain medications (non-steroidal anti-inflammatory drugs) during episodes of cold or musculoskeletal pain.
Therefore, it is essential for you to discuss potential causes thoroughly with your attending physician.
4.
When clinicians address chest pain, the first four critical conditions to rule out are myocardial infarction, pulmonary embolism, pneumothorax, and aortic dissection.
If none of these conditions are present, differential diagnoses should consider lung tumors, lung abscesses, pneumonia, tuberculosis, arrhythmias, congenital heart disease, myocardial ischemia, pericardial issues, reflux esophagitis, esophageal tumors, esophageal structural abnormalities, musculoskeletal issues, and neuropathies.
Anxiety disorders, hypochondriasis, and somatoform disorders should also be considered.
Personally, I believe that if you do not have risk factors such as hypertension, diabetes, hyperlipidemia, obesity, smoking, alcohol abuse, hormone therapy, or a family history of such conditions, the likelihood of having an aortic dissection or carotid dissection is quite low.
5.
If you have further questions, please discuss them in detail with your family physician or attending physician.

Reply Date: 2021/08/26

More Info

When it comes to chest discomfort, distinguishing between esophageal and cardiac causes can be challenging, especially when symptoms overlap. Based on your description, it seems that your discomfort is more likely related to esophageal issues rather than cardiac problems. Let’s break down the symptoms and the possible causes.

Symptoms Analysis
1. Nature of Pain: You mentioned that the pain occurs particularly during meals and subsides afterward. This pattern is often indicative of esophageal issues, such as esophagitis or gastroesophageal reflux disease (GERD), where the esophagus becomes inflamed or irritated, often due to acid reflux. The pain can be exacerbated by certain foods, especially spicy or acidic ones.

2. Location of Pain: The esophagus runs behind the sternum (breastbone), which can lead to discomfort that feels similar to heart-related pain. However, cardiac pain is typically more intense and can be associated with other symptoms such as shortness of breath, sweating, or radiating pain to the arms or jaw.

3. Associated Symptoms: You noted that the pain is mild and occurs with belching, which further supports the idea of esophageal irritation. Cardiac issues usually present with more severe and persistent pain.

4. Duration: You mentioned that the discomfort has lasted for 3-4 days. Esophageal irritation can take time to heal, especially if it is due to inflammation. If it is indeed esophagitis, symptoms can improve within a week or two with appropriate dietary changes and possibly medications like proton pump inhibitors or antacids.

Cardiac Concerns
Your concern about cardiac issues, especially in light of recent news about serious conditions like aortic dissection, is understandable. However, your doctor’s assessment that your heart sounds fine and that you do not exhibit classic symptoms of a heart problem is reassuring. Cardiac pain is often described as a heavy pressure or squeezing sensation, and it typically does not improve with changes in position or after eating.

Recommendations
1. Dietary Modifications: Since your doctor suggested avoiding spicy foods, it would be wise to follow that advice. Additionally, consider avoiding caffeine, alcohol, and carbonated beverages, which can exacerbate esophageal discomfort.

2. Over-the-Counter Medications: Antacids or medications that reduce stomach acid can help alleviate symptoms if they are related to acid reflux or esophagitis.

3. Monitoring Symptoms: Keep track of your symptoms. If they worsen or if you develop new symptoms such as severe chest pain, shortness of breath, or dizziness, seek medical attention immediately.

4. Follow-Up: If symptoms persist beyond a week or two, or if you have concerns about your heart health, consider scheduling a follow-up appointment with your healthcare provider. They may recommend further evaluation, such as an esophagram or an endoscopy, to assess the esophagus directly.

Conclusion
In summary, while your symptoms are concerning, they are more suggestive of esophageal irritation rather than a cardiac issue. It is essential to monitor your symptoms and make dietary adjustments as recommended. If you have any doubts or if your symptoms change, do not hesitate to seek further medical advice. Your health and peace of mind are paramount, and it’s always better to err on the side of caution when it comes to chest discomfort.

Similar Q&A

Understanding Chest Pain: When to Seek Help for Heart Issues

Hello Doctor, during the New Year, I started experiencing chest pain and tightness, occasionally accompanied by fatigue. I also feel like my heart skips a beat (this has happened three times since the New Year). However, when I measure my blood pressure and heart rate, they are w...

Dr. Li Han reply Cardiology
Hello Mr. Tsai, based on your description, there are two issues. The first is the symptom of chest pain, which is difficult to determine due to its brevity. However, if the symptoms are localized to the chest area (slightly left of the midline), about the size of a fist, with a d...

Understanding Chest Discomfort: Causes and When to Seek Help

Hello, I experienced a feeling of tightness in my chest while sleeping at night, somewhat like a cramp, and also a sensation similar to the pressure of swallowing a stone. However, it was not very intense and disappeared shortly after. The location is approximately in the middle ...

Dr. Yang Wenda reply Pulmonology
Hello Mr. K: Based on your symptom description, there is a preliminary suspicion of heart disease (angina) or gastroesophageal reflux disease (GERD) if you are experiencing symptoms such as acid reflux or upper abdominal pain. It is recommended that you visit a cardiology clinic ...

Understanding Chest Discomfort: Is It Respiratory or Cardiac?

Hello doctor, I would like to inquire about something that has happened recently. For the first time, I suddenly experienced difficulty breathing, a feeling of tightness in my chest, and an increased heart rate, making me feel like I was about to die. It felt like there was a sto...

Dr. Jian Shuntian reply Pulmonology
Hello: It may be a heart issue, so you can consult a cardiologist and consider a 24-hour Holter monitor. If there are still no results, you can see a pulmonologist. If everything is normal, you may want to see a psychiatrist to check for any anxiety issues.

Chronic Left Chest and Back Pain: Heart Issues or Acid Reflux?

Hello doctor, I am 34 years old and weigh 135 kilograms. For the past five years, I have been experiencing pain in my left chest, left back, and left armpit. The pain is persistent, and sometimes it is accompanied by shortness of breath. The discomfort worsens after eating or dur...

Dr. Bai Xiyan reply Cardiology
The response to the chest pain inquiry from an online user is as follows: 1. Chest pain can arise from various locations and may include conditions such as angina pectoris, aortic dissection, pericarditis, pulmonary embolism, mitral valve prolapse, pleuritis, myositis, neuralgi...