- Gastric pain is a great mimicker of cardiac pain.
- It may have , almost all the typical characters of angina . . . in some cases ECG changes too.
- The confusion is complete , as esophageal pain can also be relieved by sublingual nitrates !
- The issue is further complicated, when esophagus and coronary artery share the same neural codecs, and each may induce spasm among themselves !
- It is thought , of course with some evidence ! many of the syndrome X patients ( positive stress test with normal coronary arteries ) have esophageal motility disorders.
- The ST segment depression during EST in these patients is apparently attributed to stress induced esophageal spasm !
- And many of the patients with variant angina , have associated esophageal sapsm .
Read this land mark concept paper documenting the neural link between esophagus and the coronary artery
Click on the article
Final message
- Don’t ever forget the esophagus in your scheme of things when evaluating CAD.
- Realise that esophageal disorders not only cause non cardiac pain but also cause ischemic chest pain (Also called linked angina)
- EsophagEal smooth muscle cell can exert electrical influence on the ST segment of cardiac ECG !(After all every cell
has an action potential )
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