DO YOU GET HEARTBURN? Stomach contents heading back into the esophagus (gastroesophageal reflux) are not unexpected. For many, these episodes are fleeting and do not cause symptoms or injury to the esophagus.

Gastroesophageal reflux becomes a problem when it causes significant damage to the esophagus or symptoms.

Today we look at the physiology of gastroesophageal reflux, causes, symptoms, diagnosis, and potential non-medical interventions for management.

We’ll end with the observation that those who sleep on their left side have less potentially harmful stomach acid than others.

What is reflux (GERD)?

At your stomach’s entrance is a functional valve, a muscle ring known as the lower esophageal sphincter (LES). Usually, the LES closes after food passes through it.

If the sphincter does not entirely close (or it opens too frequently), stomach acid can move backward into your esophagus. With this retrograde acid flow, one can experience symptoms such as burning chest discomfort or heartburn.

WebMD offers that if acid reflux symptoms happen more than twice per week, you may have acid reflux disease, also known as gastroesophageal reflux disease (GERD).

If your symptoms of acid reflux occur more than twice weekly, you may have gastroesophageal (acid) reflux disease.

Reflux: Common risk factors

A common cause of acid reflux is a hiatal hernia. This condition happens when the upper stomach and the lower esophageal sphincter slip above the diaphragm (the muscle separating your stomach from the chest). If you have a hiatal hernia, acid can more easily move up into your esophagus, causing acid reflux disease.

Other risk factors for acid reflux disease include:

• Being overweight or obese
• Consuming large meals or lying down right after eating
• Eating certain foods, for example, such as spicy or fatty foods. Some get heartburn from citrus, tomato, mint, garlic, or onions.
• Drinking beverages such as alcohol, carbonated drinks, coffee, or tea
• Smoking
• Being pregnant
• Taking certain medicines (aspirin, ibuprofen, certain muscle relaxers, and some blood pressure medicines are examples)

Reflux (GERD): Symptoms

The Mayo Clinic (USA) explains that common symptoms of gastroesophageal reflux disease (GERD) include:

• Chest pain
• Heartburn (a burning sensation in your chest, typically after eating). Heartburn can be worse at night.
• Swallowing difficulty
• Regurgitation of food or sour liquid
• Lump in your throat sensation

This burning can occur anytime but is often worse after eating. For many, heartburn gets worse when they recline or lie in bed, making getting good sleep a challenge.

The Mayo Clinic offers that you should seek immediate medical care if you have chest pain (especially if you also have shortness of breath or jaw or arm pain). These may be symptoms of a heart attack.

Make an appointment with your doctor if you have severe or frequent GERD symptoms. Also, check-in with your healthcare provider if you use over-the-counter medications for heartburn more than twice weekly.

The perils of GERD

Did you know that more than 75 percent of individuals with asthma have GERD? Those with asthma are twice as likely to have GERD as those without the condition.

Gastroesophageal reflux disease may worsen asthma symptoms, and asthma drugs can worsen GERD. But treating GERD often helps to relieve asthma symptoms. The mechanism of action is not clear.

GERD (chronic acid reflux) can be dangerous or even life-threatening. It’s not the GERD per see that is the issue; instead, chronic GERD can promote:

• Esophagus inflammation (esophagitis). Stomach acid can irritate and inflame the esophagus lining, culminating in heartburn, chest pain, bleeding, or challenges swallowing.
• Barrett’s esophagus. About ten percent of those with chronic GERD develop this condition. Here, the long-term damage from acid hitting the esophagus lining can cause cells to be abnormal; when this occurs, we call it Barrett’s esophagus, a risk factor for esophagus cancer.
• Esophagus cancer. Adenocarcinoma is a cancer type that typically develops in the lower esophagus. Squamous cell carcinoma more commonly affects the middle and upper esophagus.
• Strictures. The damaged esophagus sometimes becomes scarred, resulting in narrowing of the structure. Strictures can make drinking or eating challenging.

GERD and sleep position

Medicines can help with GERD. Many can benefit from lifestyle interventions. For example, try sleeping on your left side. This position appears to be the best sleeping one for people with GERD, as it reduces reflux episodes. On the other hand, sleeping on your back can make reflux more likely.

An old-school trick is to raise the head of the bed. Propping it up (not just putting more pillows under your head) by at least six inches may reduce your reflux when you are lying down.

You can find some more intense interventions for GERD here:Treatment for GER & GERD | NIDDKYour doctor may recommend that you make lifestyle changes and take medicines to manage symptoms of gastroesophageal…www.niddk.nih.gov.

GERD — my take

If you have symptoms of GERD, please discuss them with a healthcare provider. Having a good weight can help us dodge acid reflux. In addition, don’t eat overly large meals or lie down immediately after eating.

Be careful with spicy or fatty foods, citrus, tomato, garlic, mint, and onions. I try to avoid peppermint in the evening but have no trouble with it during other times of the day.

I don’t drink alcohol but do consume e risk-increasing coffee and tea. I am sure you are not surprised that I don’t smoke. Finally, be careful with the medicines such as aspirin, ibuprofen, certain muscle relaxers, and some blood pressure medicines.

The post Heading Off Heartburn appeared first on Medika Life.

This is what a heart attack can feel like.

But is a heart attack the only thing this could be? Is this the only way a heart attack can feel? Should you drive yourself to the hospital or call 911? How is a heart attack diagnosed? What exactly is a heart attack? What’s going to happen next?

You’re filled with questions.

This article will answer many, if not all, of them.

Why should you read this? What are my credentials?

I’m an Emergency Physician — an “ER Doc” — who spent 37 years in the medical field before retiring in mid-2020. About a third of those years were spent in the private sector directly caring for patients, many of whom were having heart attacks. The other two-thirds of my career was in the academic/university sector, still caring for patients but also researching, writing, and teaching. In particular, I taught medical students and young doctors in training, teaching them how to be better doctors.

I’ve cared for hundreds of patients with heart attacks and many thousands more with symptoms suggesting a heart attack that turned out to be something else. Also, I’ve cared for many people whose symptoms were unlike the classic description above, but still, it turned out that they too were having heart attacks.

What is a heart attack?

Let’s break down “myocardial infarction,” the precise medical term for “heart attack.”

Myo = muscle (made up of cells)

Cardial = referring to the heart

Infarction = death

Putting this all together, a heart attack or myocardial infarction is the “death of cells that make up heart muscle.”

How common are heart attacks?

Roughly 1,000,000 to 1,500,000 Americans have heart attacks each year. About one-third of these individuals die.

How does a heart attack usually happen?

The heart is a muscle made up of cells. Just like other muscles, the heart’s muscle cells depend on a steady supply of oxygen from the bloodstream to live and function properly. And just like other muscles, open blood vessels are necessary for the heart’s muscle cells to receive blood and oxygen. When one of these blood vessels is blocked, heart muscle cells die. Heart muscle cell death is a heart attack or myocardial infarction.

A blood clot in an already-narrowed blood vessel that supplies heart muscle is the usual cause of a heart attack.

What happens in the United States and in many places in the world when you go to the hospital concerned that you’re having a heart attack?

You see someone just like me, an ER Doc. If it’s a heart attack, a cardiologist — a heart specialist — will be involved in your care, slightly later. But, you’re generally met in your hospital’s Emergency Department by an Emergency Physician who can immediately begin treatment, potentially save your life and diagnose your condition.

Why should you call 911, the paramedics, when you think you’re having a heart attack?

Paramedics too can immediately begin treatment and potentially save your life. They cannot diagnose your condition with absolute certainty but they can do an important first test — an EKG (or ECG) — and monitor your condition. They can intervene with certain helpful treatments and begin life-saving measures if they are called for. Paramedics can also go “lights-and-sirens,” getting you to the hospital quickly and in the safest way possible.

Some other helpful tips: remain as calm as possible, have someone stay with you, call 911 without delay, chew and swallow an aspirin, sit or recline quietly, do not panic.

What is an EKG (ECG)

An electrocardiogram (EKG/ECG) is a “heart wave tracing,” a record of the heart’s electrical activity. This recording gives doctors and others in healthcare a tremendous amount of useful information. Often, but not always, a heart attack can be immediately diagnosed by the EKG’s distinctly abnormal pattern indicating that heart muscle damage has occurred.

Why do I write “often, but not always” above?

An EKG is a useful test and frequently a helpful one, providing lots of relevant information, but IT IS NOT A PERFECT TEST. There are no perfect tests in medicine. In other words, a person’s EKG can be normal and they’ll still be having a heart attack. Also, someone’s EKG can be abnormal and it does NOT signal that they’re having a heart attack.

Physician judgment and interpretation of the information an EKG provides figures heavily into decisions that are made about whether or not an individual is having a heart attack.

Also, other tests, including x-rays, laboratory investigations, CT scans and more can be, and often are, done to help determine what is really going on.

Again, an EKG is an important test in someone suspected of having a heart attack, but it is just one test among many that can and will be done. It’s interpretation in context is critically important. The information provided by an EKG is NOT perfect. To repeat, a normal EKG does NOT mean no heart attack, and an abnormal EKG does NOT necessarily mean a heart attack has occurred.

What other tests are immediately done to diagnose a heart attack?

In addition to the EKG, a blood test measuring troponin is done. This substance, a so-called “biochemical marker,” is released into the bloodstream when heart muscle cells die. Troponin testing is often done several times even in the Emergency Department.

The combination of an abnormal EKG, particularly one that that is abnormal in a very specific way, and an elevated troponin level, usually provides enough information to diagnose a heart attack.

What else can feel like a heart attack

This is not a complete list by any means, but other medical problems with similar or overlapping symptoms can be: pulmonary embolism (blood clot in the lungs), heart muscle inflammation or infection, aortic dissection (tearing of the large artery that exits the heart and supplies blood to the rest of the body), infection or inflammation of the heart’s covering membrane, diseases of the esophagus (muscular tube connecting the mouth with the stomach), and MANY others.

Hospitalization — yes/no?

Again, physician judgment, a variety of tests, and even some days in the hospital to allow further evaluation may be required to determine whether or not a heart attack has occurred. If one has occurred, determining its extent (size and location) and assessing its immediate aftereffects should occur in the hospital. Hospitalization will also allow for other tests to be done, if required, if a heart attack is NOT the diagnosis or not the only diagnosis.

Therapy for heart attacks starts in the Emergency Department and continues in the hospital. This may include surgery to bypass blocked blood vessels, medications and other treatments to open blocked blood vessels, medications to limit a heart attack’s size and severity, medications to treat associated medical conditions, and more.

Do all heart attacks feel like the description above?

The short answer … no!

That is a fairly classic or “textbook” description. Many people including women, diabetics, the elderly, and those with certain other conditions may experience a wide variety of other symptoms, or almost no symptoms at all. “Silent” heart attacks can and do occur. These are heart attacks without any symptoms at all or perhaps no symptoms that patients can remember.

By way of example, I’ve seen elderly patients with behavioral changes who turned out to be having heart attacks, women with shortness of breath only, diabetics with what seemed like indigestion or upper abdominal pain, and MANY others.

Bottom line — if you are concerned about a set of symptoms, even including mild chest discomfort, mild breathlessness, skipped heartbeats, a feeling of “indigestion” and others, seek medical attention. Let medical professionals decide if it’s a heart attack or something else

Do only old people have heart attacks?

Again, the short answer is NO!

People of any age, including teenagers and twenty-somethings, can have heart attacks. I’ve seen this happen.

Even infants and children can have them, rarely, but they do occur.

Heart attacks do become increasingly common as age increases.

What can you do now to help prevent a heart attack?

There are a variety of conditions and so-called risk factors that lead to narrowing of the heart’s blood vessels (the “coronary” blood vessels) leading to a heart attack.

Some of these include advancing age, smoking, overweight and obesity, diabetes, a family history of coronary artery disease, elevated cholesterol, high blood pressure, and more.

Some of these conditions and risk factors are under your control and some are not.

Smoking is known to be a significant risk factor for heart attack and is completely under one’s control. So, if you smoke, quit!

Avoid weight gain if possible. Seek to lose weight if you’re overweight.

Obtain treatment for other conditions that lead to coronary artery disease and heart attack.

Bottom line — heart health, heart attack risk, and strategies to avoid heart attacks are complex, long-term issues best discussed with your primary healthcare provider.

The post How to Tell if You’re Having a Heart Attack appeared first on Medika Life.

A burning sensation that starts in the chest and expands. Or maybe it’s a clenched fist in the stomach or a mysterious lump that cannot be swallowed. Perhaps it’s an unusual urge to cough.

Though the symptoms may vary, the cause is the same.

No shortage of stomach acid

Acid reflux, gastroesophageal reflux disease (GERD), sour stomach, or heartburn. They all describe the same condition: gastric acid hypersecretion, or too much stomach acid.

Overproduction of stomach acid can lead to a host of problems. An ulcer can occur when acid destroys the stomach’s protective layer of mucus. This leaves the inner lining vulnerable to damage. Ulcers may also form in the small intestine.

Ulcers can also be caused by a bacterial infection of H. pylori. In this case, medical intervention is essential as H. pylori can only be treated with a course of antibiotics.

GERD is the word

Gastroesophageal reflux disease (GERD) is what gives us those classic heartburn symptoms.

When gastric acid flows the wrong way back up into the esophagus, it is called reflux. Normally a gateway, called the esophageal sphincter, prevents this backflow. However, multiple factors can cause the esophageal sphincter to relax, allowing acidic contents in the stomach to escape.

These include:

• Increased age
• Pregnancy
• Smoking
• Medications like NSAIDs, heart medications, and anti-anxiety medications
• Diet
• Certain types of hernia
• Obesity

The result is pain, burning, discomfort, and if left untreated, inflammation, and eventual build-up of scar tissue. Scarring can cause the tube-like esophagus to narrow, making it difficult to swallow food. This is known as esophageal stricture, and treatment may require surgical placement of a stent.

These long term complications are why it is imperative not to let chronic heartburn go untreated.

Mandatory Disclaimer

Before undertaking any self-treatment with over-the-counter medications, have a discussion with a doctor or pharmacist. Occasionally the symptoms of heartburn can be similar to a more serious cardiac issue. This is especially true for women, who may not always display the classic signs of a heart attack.

Lifestyle modifications- unsexy advice

As a pharmacist, my first recommendation is non-pharmacological intervention. No one wants to hear it, but losing weight and quitting smoking will help. So will resisting the urge to sleep on the couch after a heavy meal. Avoiding trigger foods is also sage advice.

For me, heartburn started in my 30s. Eating fried foods would trigger my symptoms without fail. While fatty foods are a common no-no, others include:

• Protein-rich meals
• Spicy foods
• Alcohol
• Chocolate
• Acidic foods like citrus, grapes, pineapples, and tomatoes
• Peppermint
• Caffeine

I know. All the things that make life worth living.

Remember, not all of these foods will be triggers for everyone. My advice is to try an elimination diet. Take away foods that are believed to cause the pain and add them back one at a time. Soon you will have your culprit.

Stress is another cause. So many of our physical problems stem from mental ones.

I would always feel heartburn take hold after I had been at work for about an hour. I could go on about relaxation techniques — taking deep, cleansing breaths, and allowing for frequent breaks. But honestly, the only thing that helped me was not eating before going in to work.

So you’ve tried all these tips and still have heartburn? Then it’s time for a chat with your doctor or pharmacist.

Antacids

For mild, occasional heartburn, the first-line treatment consists of antacids. Maalox, Mylanta, and Tums are all examples.

Maalox and Mylanta are twins; a combination of aluminum and magnesium that works quickly to neutralize the acid in the stomach. Additionally, these thick liquids coat the stomach walls, providing a temporary protective layer.

Tums, a chewable tablet, contains calcium carbonate, another fast-acting acid neutralizer.

Antacids are all similar in efficacy. Let such factors as liquid versus chewable or price be your guide.

You may see a product called simethicone added to antacids. This agent reduces gas. It will not directly help manage heartburn symptoms. However, if you feel bloated or experience lower abdominal pain, simethicone could be useful.

Aside from icky taste, there are no major side effects for antacids.

It is a good idea to space antacids apart from other medications by at least 2 hours. The compounds in them can bind with other drugs, making them difficult for the body to absorb. This is especially important with antibiotics and medicine used to treat thyroid conditions and bone loss.

Use caution in individuals with kidney disease as the buildup of magnesium, aluminum, and calcium in the body is a potential problem.

Remember, antacids are only for short term use — 1 to 2 weeks. If they are not helping, consider adding or switching to an H2 blocker.

H2 Receptor Blockers

Also known as H2 receptor antagonists, these medications are a good choice for heartburn as they help to treat the cause. Although their onset of action is slower than antacids, about 1 hour, their duration lasts longer.

H2s work by blocking histamine receptors in the stomach. This blocking, or antagonism, prevents the signal that leads to the production of gastric acid.

Four brands are currently available over-the-counter (OTC):

• Axid (nizatidine)
• Zantac (ranitidine)
• Pepcid (famotidine)
• Tagamet (cimetidine)

I feel most comfortable recommending Pepcid due to its long history of use and the near absence of drug interactions.

Tagamet, as the first on the market, has the most adverse effects. Tagamet also affects liver enzymes more than the others and therefore displays more serious drug-drug interactions.

Zantac, normally a great choice,has been temporarily recalled for NDMA contamination — a possible carcinogen.

Axid was the last player to enter the H2 blocker arena, and as such, never gained as much popularity.

Side effects of H2 blockers are mild and include headache, nausea, and vomiting.

They are generally well-tolerated, but individuals with poor kidney function should avoid using H2 blockers long term. When used sparingly, the dose should be cut in half.

Limit self-treatment with H2 blockers to no more than 2 weeks without consulting a doctor. This is especially important as longer treatment appears to result in tolerance to the drugs with a resulting decreased efficacy.

Proton Pump Inhibitors

Proton pump inhibitors (PPIs) are gaining in popularity since a few made the switch from prescription (RX) to OTC a few years ago.

This class of drug displays the most benefit in reducing damage caused by the overproduction of acid. PPIs work by shutting down the pumps that produce gastric acid, giving the stomach a chance to heal.

The success of Prilosec (omeprazole) launched a series of competing “me too” drugs.

Other PPIs that made the RX to OTC switch include Nexium (esomeprazole) and Prevacid (lansoprazole).

In general, there are no practical differences between these three drugs. Honestly, pick whichever one appeals to the pocketbook.

Expect that PPIs will take a few days to start working. It may be beneficial to continue using antacids or H2 blockers until the full effects are felt.

PPI media hype: sifting truth from fiction

There have been many media reports about the dangers of PPIs. Many of these are unwarranted as this class of drugs is generally recognized as safe. Realistically, the most common side effects are headache, rash, and diarrhea.

However, when used long-term, PPIs do come with a few caveats.

Certain populations using PPIs, like the elderly or immunocompromised, appear to have an increased risk of infection. Clostridium difficile, a particularly nasty bug that causes severe diarrhea, and pneumonia are of greatest concern.

The theory is the acidic environment in our stomach normally suppresses bacterial overgrowth. If we neutralize this defense, bacteria can flourish.

Incidentally, there may be a correlation between PPI use and coronavirus. Early data suggests a link between low amounts of stomach acid and the proliferation of the coronavirus — leading to more positive tests. However, further research is needed.

Increasing the pH of the stomach may also lead to absorption problems. Calcium, magnesium, and vitamin B-12 are a few of the affected essential vitamins and minerals. Low calcium is of special concern to an elderly population already at increased risk of bone loss, or osteoporosis.

Consider talking to your doctor or pharmacist about supplementation.

It is also recommended not to abruptly quit PPI use after long-term therapy. Slowly tapering off the drug avoids the rebound effect of increased acid production.

Drug interactions with PPIs mainly result because of competition for the liver enzymes that aid in metabolism. However, they can also be a result of the increased pH in the stomach. Many drugs need an acidic environment to be activated.

Major interactions between PPIs exist with:

• Antiretrovirals (HIV medications)
• Anti-fungals
• Anti-depressants
• Chemotherapy agents
• Anti-seizure medications
• Plavix (clopidogrel) — an important antiplatelet drug used to prevent heart attack or stroke

Because of the potential for serious long term effects and severe drug interactions, I recommend talking to your doctor first before initiating PPI self-therapy.

Heartburn in pregnancy

Heartburn is a common complication in pregnancy, with the majority of symptoms occurring in the last trimester.

Studies evaluating a drug’s safety profile in human pregnancies are scarce. Usually, we rely on animal studies when making recommendations. Plus, the benefits to risk ratio must be considered.

The safest solutions for pregnant women with heartburn are the lifestyle modifications discussed earlier. Eat smaller, more frequent meals, avoid trigger foods, and elevate the head of the bed with pillows to avoid lying flat. Chewing gum to release saliva may also help promote digestion.

Consider occasional treatment of heartburn in pregnancy with a calcium-containing antacid like Tums first. Magnesium also seems to be safe in low doses. However, a few studies have agreed that limiting the amount of aluminum may be prudent.

H2 blockers have also been safely used, but it is recommended to be under a doctor’s guidance. Although they appear safe in the first trimester, PPIs should only be used under doctor supervision.

Summary

Although it seems a minor inconvenience, heartburn can lead to more serious problems. It should never be ignored.

Avoid or limit those trigger foods, and make appropriate lifestyle changes when possible.

Consider treating the occasional mild case of heartburn with an antacid. Add an H2 blocker, like Pepcid, if no relief.

If no comfort is felt from either agent, it is reasonable to consult with a doctor or pharmacist before starting a PPI. Although they work best, they also have the most potential long term effects and drug interactions. Also, a checkup can help rule out other causes.

Never ignore warning signs of a more serious condition such as:

• Blood in the stool
• Unexplained weight loss
• Food getting stuck in the throat

With a few changes, heartburn does not have to be a daily event. That fire in the stomach can be extinguished.

The post A Definitive Guide to Heartburn and Alleviating the Symptoms appeared first on Medika Life.