MCC mimicker of angina, pain is due to chronic irritation of the esophagus resulting is spasm
Distinguished based on a thorough history.
| GERD | Angina | |
|---|---|---|
| Symptoms | • Substernal burning or dull pain; may radiate to arms, neck, jaw | |
| • Frequently accompanied by cough or reflux, regurgitation or dysphagia | • Substernal pressure; may radiate to arms, neck, jaw | |
| • Frequently accompanied by dyspnea | ||
| Symptom duration | • Prolonged, constant (eg, >1 hr) | • Short, intermittent (eg, 2-5 min for chronic angina; >15 min suggests ACS) |
| Precipitating factors | • Recumbency | |
| • Trigger foods (eg, alcohol, coffee) | • Physical exertion | |
| • Stress | ||
| Alleviating factors | • Antacids | • Rest |
| • Nitroglycerin |
<aside> 💡 In contrast, pain radiation is a less reliable distinguishing factor. Pain fibers from the esophagus and heart (visceral afferents) overlap at multiple different spinal cord levels, where they converge with somatic nerves. Therefore, chest pain caused by esophageal or cardiac pathology can be referred to the arms, jaw, neck, and/or back.
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<aside> 💡 Musculoskeletal pain is typically sharp, is localized to a specific area over the chest wall, and may be reproducible on palpation or aggravated by movement or change in position.
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