Mario A. Martinez, M.D.
We frequently have patients complain of chest pain that is caused by acid reflux. Cardiac chest pain usually occurs with exertion. Gastroesophageal reflux disease (GERD) usually occurs after meals or when lying down. People with GERD symptoms often complain of waking up with chest pain or chest pain that occurs in the morning. Cardiac chest pain rarely occurs at rest and usually resolves in 3 to 5 minutes with rest. Cardiac chest pain rarely occurs in young people. Chest pain from GERD very closely mimics cardiac chest pain but it can last for hours. It usually only goes away after taking antacids. The reason these two types of chest pain are so similar is because they both cause sudden, powerful stimulation of the vagus nerves.
There are 12 pairs of cranial nerves. These are the nerves that leave the brain directly. Most nerves come off of the spinal cord. One pair of cranial nerves are the vagus nerves. They leave the brain and go down the sides of the esophagus. A branch comes off of each side and forms a network of nerves over the heart called the cardiac plexus. They form a network of nerves over the second half of the esophagus as well. This is called the esophageal plexus.
When an older person has a heart attack, it causes sudden, powerful stimulation of the vagus nerves via the cardiac plexus. Sudden vagal stimulation causes chest pressure, nausea, sweating, shortness of breath, dizziness and palpitations. Not all of these symptoms occur every time.
The sphincter between the stomach and the esophagus is a very weak sphincter formed by the diaphragm. This is the large muscle of respiration. It fails to some degree usually by the time we are about 30 years old. The stomach is designed to tolerate the very high concentration of acid it produces but the cells that line the esophagus are not. When stomach acid washes up into the esophagus, it causes a lot of irritation to the lining of the esophagus. This causes sudden, powerful stimulation of the vagus nerves via the esophageal plexus. Sudden, strong stimulation of the vagus nerves in this case also causes chest pressure, nausea, sweating, shortness of breath, dizziness and palpitations.
Untreated, severe acid reflux can lead to stomach and esophageal cancer as well. This is because the strong acid of the stomach contents can cause changes to the DNA in the cells that line the esophagus. Acid reflux is often inhaled while a person sleeps. While a person is lying down, the acid does not have to fight against gravity to work its way up to the back of the throat. We don’t protect our airway while we sleep the way we do while we’re awake. When a person inhales acid reflux, it causes symptoms like bronchitis. It causes changes on chest xray that appear like bronchitis as well. This is often what is occurring when a person has recurrent bronchitis that does not respond to antibiotics.
The bottom line is that if you have a problem with acid reflux, it needs to be treated. If you have a severe problem, you should take some medicine every day. If you have occasional symptoms, you should take a medication for several days when you have symptoms, then stop.