Exertion Causing Heartburn?

[Baruther]

For the last few months, my dad has complained of “heartburn” that seems to be triggered by exertion, and not by food.  He is a 66 year old African American man, who is overweight, and has not used any tobacco in roughly 20 years.  He is 6 feet tall and weighs 240lbs.  His primary care physician says that his cholesterol is a little high, but has never prescribed drugs or diet changes.  He does not drink alcohol, and has fairly poor diet and exercise habits.

Because of this pain in his chest, his doctor ordered an “Upper GI” and a “stress echo”.  Results of each test were reported as normal.  It was recommended that he have a “lower GI” test done, and just today a family friend who is a physician suggested that the stress echo is only 80% accurate and he should have an “angiogram”.  On two occasions the pain in his chest was so severe that he went to the nearest emergency room, where his blood pressure, pulse rate, chest x-ray, and enzyme levels were found to be normal.

We are terrified that something is really wrong.  Because it feels like heartburn, my dad keeps calling it heartburn.  Since it started, he has become even more sedentary, and I fear he will gain even more weight.  Are these symptoms consistent with any condition that you are aware of?  Should we be thinking that this is cardiac or gastronomical or neither?  What are other possibilities?

Barrington

[Fionajnz]

It sounds to me like it could be angina of some sort, rather than heartburn.  My father had symptoms for at least 3 yrs and a reduction in his level of activity - significant, he could not walk even a block, without chest pain by the time he was cath'ed.  He minimized it completely to everyone but especially my Mum and the three of us.  

However, he was told by his GP repeatedly,  it was not a problem (this is social medicine in New Zealand), and until he was basically confined to a chair, he would not get a cath ordered.  As I recall they did not even do a stress test.  When I pushed him to use their private insurance (and that took a lot of pushing), he finally was cath'ed and they found a 95% plus blockage in two arteries. My point is, some men are stubborn as all get out.

If he has sought emergent care for the pain, its very doubtful that its heartburn, though not impossible.  I guess the other thing to think about is gall bladder or pancreas, but that would be checked with a complete workup.  The best thing to do, is when it comes on, have him take some liquid  maalox or similar, if its not relieved pretty much immediately, then he needs to go to the ER again asap.  Then be completely evaluated for chest pain.  That is what he should check in with as his symptoms at the desk, NOT heart burn.

A catheterization is  the gold standard for checking for CAD.  If there is any doubt, its worth doing the test, the worst that can happen is they find nothing, the best that can happen is they find something, fix it and he feels much better.  Best of luck with this.

Fiona  

[Cleveland Clinic]

It sounds to me that this pain, being exertional in nature and not related to food intake, in your father who given his age and risk factors has, even without the presence of any symptoms, already a high likelihood of having coronary disease, is cardiac and not gastrointestinal in nature. Give the severity of the pain, the fact that is occurs sometimes at rest and required emergency room care, I concur with your family friend that the only test that would rule out coronary atherosclerosis is a diagnostic angiogram. A negative stress test, in this patient population by no means excludes coronary artery disease.