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Forum Name: Miscellaneous Cardiology Topics

Question: Is it GERD or angina?


 gun-powder - Fri Mar 27, 2009 10:00 am

I am a male 53 years old I had CABG surgery in 2002. A month ago I had a problem of gas burbing during walking or doing any physical activity, considering that I had lifelong problems in colon I considered it normal. Six weeks ago after getting over the stairs several times I felt a terrible pressure & pain in the middle of my chest with gas burbing,pain in jaw & left shoulder , I went to ER they made an EKG they diagnosed the problem as esophageal contractions due to GRED and the pain relieved by taking ZINTAC as injection .
Since then every night I wake up in the middle of my sleeping with the same chest pressure, I went to ER again this time they told me that my EKG this time showed some disturbance and I took again ZINTAC the pain decreased a little after rest.
After that I had a MSCT coronary angiography the report showed the following:
For the three bypasses:
-Patent LIMA graft to mid LAD.
-No other patent grafts seen.
For the native arteries:
-Significant stenotic at the proximal & mid LAD segments and at the ostium of the 3rd diagonal branch.
-Total occlusion at the mid LCX and distal RCA segments.
It was strange that the other two bypasses didn’t appear.
Any way I went to my heart surgeon he told me that I have GERD and the heart is in a good condition as the main artery pass of LAD with LIMA is ok and it feeds 75% of the heart and the problems in my EKG are due to esophageal contractions is related to the heart so it is normal have pulse and heart disturbances he told me to continue my work and live my normal life.
At work I got tired felt like exhausted and with high heartbeats and the same rate chest pain I went to hospital I stayed there for a week with plenty of tests & EKG they told me that I have some problems in both heart & GERD but they can’t do me a catheter for my arteries and also the can’t make esophageal scope tests because that would harm my heart medical condition they asked me to have a 15 day vacation.
Since I got out of the hospital I have three cases:
I can’t do any outside home activity driving a car just going to the street I feel ascending middle chest pain, high heart beat rate, gas burbing, dry through & like I have swallowed a piece of metal .
Pressure in the chest and the back during bending or having a shower.
A severe chest pain that wakes me every night nearly at 3:00Am.
Knowing that:
-I don’t have any heartburn.
-I don’t feel sweating or short breath during these attacks.
- These pain attacks don’t mainly come with physical effort.
And also I follow the instructions well:
- I sleep nearly at sitting position
- I only eat vegetable soup & bread
- I am not a smoker & I don't drink
-I don’t eat spicy food.

I have been at home for a week till now my situation didn’t get any better, should i try to with stand the pain and try to do more physical effort knowing my case is GERD and stop worrying about my heart situation until I get better or that i am having angina and i have to stop doing any effort in my daily life .

Doctors have different opinions every where I go some say GERD & some say angina i don't know which one to believe.
What I am asking about now is:
According to the MSCT Is my heart situation fine?
Are my symptoms related to anginas or it is just GERD?
If it is GERD how long would it take to start showing enhancing with medication?
 John Kenyon, CNA - Sun Mar 29, 2009 12:03 pm

User avatar Hello --

You present a very interesting and complex question. While you probably do have GERD, based on findings, you also do have progressive coronary artery disease, which has obliterated some CABG grafts as well as significantly narrowed some native vessels. It is likely you have unusual cardiovascular anatomy and have also developed some collateral blood flow, but it is difficult enough to differentiate between esophageal spasm, pain of angina, and heartburn. Since esophageal spasm will respond to nitroglycerine, this wouldn't provide enough evidence of either/or.

It seems some of the doctors who've seen you detect evidence of GERD and read your coronary anatomy to be functioning well, while others recognize the difficulty of truly knowing which may be causing your symptoms. GERD will not cause fatigue, but all the other qualifying symptoms or lack of them do point toward GERD as a likely cause of most of your complaints. However, I strongly suspect a combination, since there is no rule against having more than one medical problem at the same time, and these two do often co-exist. I would try to assert the need to manage the GERD at the maxium effective level, perhaps with a more strong medication, and also be followed regularly for changes in cardiac status. You're doing everything right, and it is a very difficult problem you face in having both things going on at once. Your angina, if there actually is any present, is probably stable, which is good. A comprehensive cardic rehabiliation program might be the best route for you right now, if you can get the doctor to prescribe one. Meanwhile, please continue doing what you are doing and follow up with us here as needed.
 gun-powder - Mon Mar 30, 2009 9:34 am

i have read before about a nerve called vagus nerve which is common between heart and esophagus do you think that am related to this diagnosis and my anxiety affects this nerve related symptoms
 John Kenyon, CNA - Tue Mar 31, 2009 12:04 pm

User avatar While I don't think you have any disease process involving the vagus nerve, this nerve does play an important role in a lot of cardiac symptoms, especially heart rate and sometimes rhythm, and it also controls the peristaltic action of your GI tract, so when your stomach or intestines are acting up in some way (which would likely include GERD if due to excess acid production) then yes, this could cause vagal stimulation which might well lead to premature heartbeats, palpitations and slowing of the heart rate. It wouldn't cause chest pain, but it can cause other symptoms simply by its having two basic jobs: to slow the heart rate and to help the GI tract digest food. Hope this clarifies that part for you.

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