Worried about heart symptoms?? - or am I being silly?

Hello, I am a 49 year old mother of 2 teenage daughters.  Just over a year ago I was diagnosed with type 2 diabetes for which I am now taking Metformin 500mg a day.  I am also taking meds for high cholesterol and high BP.  I am taking Thyroxine for Hypothyroidism (under active) - Thyroxine 100mcg daily - a condition that I have had since 1997.  I am 3 stone over weight at 13stone 7lbs (and need to lose it).  I have also had the condition PCOS since the early 1990's, which caused me fertility problems, for which I needed some medical intervention with.  I have what is called I suppose 'Metabolic Syndrome' and find it so hard to lose the weight - although I should also exercise more.  My worry is that for a few years now and moreso recently I have experienced slight burning sensations with dull pain on the left side of my chest radiating into my shoulder blade and arm.  This happens intermittently and there is no pattern to it at all.  I am worried because of all the above problems that I might be developing heart disease?  I have had ECG's done in the past which are always normal and I also did an exercise stress test, which was also all normal (approx 2 yrs ago).  Also for a few years now I have experienced pain that generally starts in the base of my throat and can radiate to my jaw, teeth, sometime ears and down into across my chest and can last for 5 to 20 mins.  My doctor thought it was osophogeal spasm and sent me for a barium swallow - which ws normal - could this be related?

[kenkeith]

Osophogeal spasm does have chest pain that is almost identical to coronary occlusions.  
Esophageal spasms can be difficult to diagnose because of their similarity to other disorders, such as gastroesophageal reflux disease (GERD), a condition in which stomach acid or bile flows back (refluxes) into your esophagus, irritating its lining.

Esophageal spasms are more common in women, and the incidence increases with age. If you have gastroesophageal reflux disease, you may be more prone to esophageal spasms. Your doctor may test you for reflux or try a medication targeted at acid reflux. Has that been done?

[erijon]

The reason that the pain from an esophageal spasm mimica the pain from a heart attack is because it also affects the same vagus nerve bundle that is affected during a heart attack. For this reason it can result in pains that radiate to the same areas affected by the vagus nerve. In addition, if it is a true esophageal spasm it can be relieved with nitro as it works the same way as it does in a heart attack. This is why your doctor sent you in for a barium test. It is important to determine the cause, as Ken stated an helicobacter pylori (h-pylori) bacteria test will help determine if it is related to an inflamed esophagus due to reflux. If this is negative you may want to discuss another stress test but with nuclear imaging to be safe.

Hope this helps,

Jon

[ireneo]

I'm still trying to collect information about the differences between esophageal spasms and true angina. So would you say a person typically has GERD if they have esophageal spasms? Can a person have the spasms alone without any digestive problems?

Obviously I ask because I do have chest pain during exertion (not much now that I'm on Diltiazem) but I can eat just about anything without problem. Jalapenos? Fine. Habanero salsa? Fine. But carry groceries upstairs? Not so fine. The pain eases pretty quickly if I just stop and wait. The cardio didn't think it was heart related but I never felt quite comfortable with that answer. As long as I take the Diltiazem, I'm in pretty good shape.

[erijon]

Yes it is possible to have esophageal spasms without have GERD. For instance, eating food that is either hot or cold can trigger an esophageal spasm.

Jon

[ireneo]

Not trying to hijack this thread, just trying to figure out the differences between the two. One last thing and then I'll back out. Can exertion (walking too quickly or walking uphill for example) trigger an esoph. spasm then? I wonder if certain breathing patterns might trigger one? I'd prefer to think my pain is esophageal than heart of course.

[kenkeith]

The exact cause of esophageal spasms is unknown. As stated, extremely hot or extremely cold foods, although how these foods may trigger the spasms is unclear.  Gastroesophageal disease (GERD) or heartburn, conditions affecting the esophagus and which may trigger spasms.
"Exercise (exertion) can induce reflux and trigger esophogeal spasm. This occurs in about 10 to 15 percent of patients. Patients in whom this occurs are typically advised to avoid excessive stooping, bending, or heavy exertion for one hour after eating".

I haven't seen anything association with breathing, gerd and esophogeal spasms.

[erijon]

Ken is correct. In addition GERD can cause issues with breathing as reflux will cause lungs to become irritated as well leading to chronic and sometimes mild bronchitis, which can be perceived as SOB.

Jon