Peter Hibberd, M.D., is a doctor whose advice is based on more than 28 years of hospital outpatient and inpatient experience. He is an experienced emergency medicine physician, surgeon, and consultant. Dr. Hibberd is certified by the American Board of Emergency Medicine. He is also a fellow and active member of the American Academy of Family Physicians, an active member of the American College of Emergency Physicians, and a member and fellow of the American Academy of Emergency Medicine. Dr. Hibberd has earned numerous national and international professional certifications, memberships, and awards.
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Are Tums an Effective Way to Deal With Chest Pain?

Thursday, 10 Jun 2010 04:27 PM

Question: I frequently have severe pain in my chest area directly behind my sternum about one to one and a half hours after eating, but it leaves immediately when I take an antacid. Is there something I can do other than just taking Tums?
Dr. Hibberd's Answer:
Chest pain of any kind needs professional evaluation promptly. I strongly discourage telephone or Internet consultation for chest pain symptoms simply because what sounds like classic gastrointestinal dyspepsia occasionally turns out to be a coronary artery spasm or ischemia (often a warning sign of an impending heart attack). Abandon the Tums routine and get yourself in for a proper evaluation without delay.
We used to treat patients in the emergency department who had what sounded like classic esophageal or gastrointestinal dyspepsia with a GI cocktail (a mixture of antacid and anti-spasm medication and local anesthetic agent) only to discover years later that we were probably missing early atypical symptoms for heart pain called unstable angina.
Today, relief of pain with a GI cocktail by itself is not sufficient to exclude the presence of an evolving acute coronary syndrome or ACS, which is the prelude to a heart attack. Of course, treatment for cardiac (heart) pain is very different from treating gastro-intestinal problems, and you need to be evaluated for the presence of both of these conditions without delay.
For those with suspected heart disease, we all know the importance of early diagnosis and early intervention. Results are usually superb as long as diagnosis is not delayed past the point where muscle damage occurs to the heart muscle (known as a heart attack), or to a point where the heart's function is interfered with by muscle irritability and conducting disturbance. This may lead to a cardiac arrest (known as sudden death) without any warning or chest discomfort.
For those with confirmed gastro-intestinal causes, there are many common precipitants. Common risk factors include alcohol and tobacco overuse, H. pylori infection, ulcer disease, malignancy, and structural disorders of function or motility of the esophagus, stomach or duodenum. These, as well as many other conditions, are easily assessed for during your initial consultation.
Fortunately, most of our upper gastro-intestinal complaints can be managed medically (versus more serious ones that require surgical intervention) and will usually respond to proton pump inhibition therapy (such as Nexium, Prilosec, and Prevacid) with appropriate lifestyle modifications. Occasionally motility and anti-spasm agents are added for relief while the underlying medical condition is corrected.
Even with these conditions, it is wiser to understand and treat the cause of the problem in order to minimize the risk of progression as well as of re-occurrence. You now have no excuse for further delay. See your doctor today.

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2010-27-10
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