Palpitation is a common symptom of heart affections, but sometimes, it is used by patients to describe an esophageal affection called “Esophageal spasm”.
“Esophageal spasm palpitations” as commonly referred by patients, are sudden painful contractions of the esophageal muscle. They can feel like sudden, severe chest pain that last from a few minutes to a few hours and they go away.
Usually esophageal spasm palpitations occur only occasionally and need no treatment. But sometimes they happen frequently and interfere with one’s ability to eat and drink. In this case, seeking medical attention is a must.
Esophageal spasms often affect people between the ages of 60’s and 80’s. Some conditions such as high blood pressure, anxiety, depression, consuming red wine, very hot foods or drinks seem to increase the possibility of developing esophageal spasm palpitations.
There are two types of esophageal spasms:
1. Diffuse esophageal spasms- In this type there are occasional contractions of the esophageal musculature. The contractions may be painful, and are often accompanied by fluid and food regurgitation.
2. Nutcracker esophagus- In this type there are very painful contractions, and the regurgitation of fluids and foods is not common.
Esophageal spasms are dangerous. Having esophageal spasm palpitations can cause malnutrition and dehydration due to its interference with one’s ability to eat and drink.
What is the mechanism?
The esophagus is a muscular tube-shaped organ responsible for the forwarding of the foods and liquids from the mouth to the stomach.
This action is achieved by the contraction of its musculature. If the case of esophageal spasms, there is an abnormality in the functioning of nerves that control the contractions of esophageal musculature.
The malfunctioning often affects the lower esophagus, but it can affect every part of it. This malfunctioning of the nerves can cause either uncoordinated, irregular spasms (diffuse esophageal spasm) or it can cause very strong regular contractions, which are very painful (nutcracker esophagus).
What about the solution?
The treatment of esophageal spasm palpitations depends on the frequency of severity of the spasms. Occasional spasms need no treatment unless avoiding the situations and foods that trigger them.
To help you cope with occasional spasms, find the following tips:
1. Avoid the triggers- avoid the consumption of foods and beverages that trigger the spasms.
2. Do not have very hot or very cold foods and drinks. Let them warm or cool before consuming them.
3. If noticing that spasms are triggered by stress, find ways to control stress.
4. Suck a peppermint lozenge- peppermint oil is a smooth muscle relaxant that eases the esophageal spasms. Place a peppermint lozenge under the tongue.
In the case of an underlying disease, treating it would result in the treatment of the esophageal spasm palpitations as well.
If having GERD your doctor might prescribe you pump inhibitor drug such as lansoprazole, or in the case of anxiety or depression your doctor might prescribe you an antidepressant such as imipramine or trazodone. Antidepressants also help in reducing the sensation of pain and heartburn.
If they happen frequently and are strong and painful, then there are some treatment options available:
1. Medications that relax the contracted muscles- To reduce the severity of the spasms your doctor might prescribe a variety of meds.
Some of the most used meds are calcium channel blocker such as diltiazem, Sildenafil, onobotulinum toxin A (botox).
2. Surgery- surgery is indicated only if medications fail to work. Surgery consists in cutting the affected part of the esophagus in order to weaken the spasm.
Peroral endoscopic myotomy(POEM)- it is a new approach, a minimally invasive technique which consists in cutting the affected part of the esophageal musculature, but unlike the classic esophageal surgery, POEM is done by inserting and endoscope within the esophagus down to the affected area.