Can Gas Cause Chest Pain

The only explanation for the cause of belching in this patient was angina pectoris. He had no other risk factors relating to a gastric problem such as drugs, relation to meals or stressful events.6 The symptoms were confined mainly to effort and emotions, which were the clues for the diagnosis. The diagnosis was confirmed by a strongly positive stress test during which he experienced the same symptoms without chest pain, besides an abnormal coronary angiography and the disappearance of the symptom after surgery.

Belching as a Presenting Symptom of Angina Pectoris

Symptoms of angina pectoris can present with the typical specific symptoms, which are easy to recognize, or vague symptoms like chills, nausea, dizziness, belching and mild chest pain. Both the typical and atypical forms of angina symptoms may rarely be associated with or masked by predominantly extra cardiac manifestations, which are occasionally referred to the abdomen. We report here an unusual presentation of angina. A 62 years old male who had been healthy all his life, presented at Sultan Qaboos University, Oman, with a two month history of belching episodes as the chief and the only complaint. He was found to have angina pectoris, although there were no classical symptoms or signs to suggest it. He was treated successfully by surgery. It is concluded that belching can be a presenting symptom of angina.

Keywords: Angina pectoris, symptoms, Eructation, Case report, Oman

I n the age of technology, simple historical features of pathologic processes are often overlooked as diagnostic aids. To most patients, belching, chills and fatigue do not sound like symptoms of heart attack. As a result, many sufferers do not seek medical attention, or they delay it, which can result in permanent damage to the heart muscle or even death.1 A recent research study indicated that most patients with recent heart attacks had symptoms different from those they expected.2 As a result, medical treatment was significantly delayed.

There is increasing awareness that associated symptoms of anginal chest pain, do not reliably distinguish between cardiac and gastrointestinal origins of chest pain, which can coexist in up to 35% of patients. Belching or painful swallowing are suggestive of esophageal disease, although belching and indigestion may be seen with myocardial ischaemia.3,4,5 Belching as an isolated symptom of angina without chest pain, have not been reported before, and was not included as a common presenting symptom of angina pectoris in the standard textbooks of medicine and cardiology. We report an otherwise healthy middle aged man with a typical anginal symptom that presented with belching and was treated successfully by surgery.

CASE REPORT

A 63 years old male, who had had normal health all his life, presented at Sultan Qaboos University, Oman, with a history of belching episodes following a sensation of gas in the stomach for two months duration. He noticed these symptoms only during physical effort such as walking, going up the stairs or with emotional stress. It was not associated with chest pain or any other gastrointestinal symptom. The belching was not related to eating meals and was absent at rest. There was no past history of epigastralgia or chest pain. He had no prior history of surgery. He had not used any medication recently and had no drug allergy.

The general physical examination was normal, including pulse and blood pressure. His body mass index (BMI) was 25. Investigations done, including complete blood count, electrolytes, creatinin, liver function tests, lipids and glucose were normal. A resting electrocardiogram was normal. A stress test electrocardiogram was strongly positive for angina pectoris. Coronary angiography showed 50% narrowing at the left anterior descending (LAD), both branches of the circumflex artery and 98% blockage of the right coronary artery (RCA) and its branch, the posterior descending artery (PDA).

The patient underwent coronary artery bypass grafting (CABAG) surgery and was put on statins and aspirin medication. Since then he has remained asymptomatic and his BMI has not changed.

DISCUSSION

The only explanation for the cause of belching in this patient was angina pectoris. He had no other risk factors relating to a gastric problem such as drugs, relation to meals or stressful events.6 The symptoms were confined mainly to effort and emotions, which were the clues for the diagnosis. The diagnosis was confirmed by a strongly positive stress test during which he experienced the same symptoms without chest pain, besides an abnormal coronary angiography and the disappearance of the symptom after surgery.

Our patient did not present with the typical specific symptoms of myocardial ischaemia, which are easy to recognize, but he presented with an atypical symptom which can easily be missed.1 Belching, chills and fatigue do not sound like symptoms of heart attack to most patients; as a result many sufferers do not seek medical attention or they delay it, which can result in damage to the heart muscle and even death.1 The relative infrequency or lack of specificity of this symptom reduces its value in diagnosing ischaemic heart disease. A good history taking helped in the diagnosis and early intervention for this patient.

Most studies report the association of belching with the chest pain of myocardial infarction, but none relates the symptom either exclusively to or associated with the pain of angina.7, 8 Previous studies reported the association of belching with inferior myocardial infarction.9 Another noticed its association with Q wave infarction and the predictive value for belching with infarction is 72%.7 These patients could have been diagnosed earlier by the general practitioner before presenting to the accident and emergency department. Sweating is not the only symptom, other than chest pain, which predicts infarction.10 Others have reported an association of nausea, vomiting and belching.8,11, This symptom can certainly also be associated with non cardiac causes of chest discomfort (such as aerophagia or peptic ulcer),12 but when it is associated with coronary artery disease, it always indicates inferior wall ischaemia.9

The mechanism may be the marked vagal stimulation associated with inferior infarction causing gastric distress and subsequent gas formation.8 The association of belching with inferior infarction suggests an enhanced autonomic response to ischaemic heart disease at this site.9 The predominance of our patient’s symptom can be explained by inferior wall ischaemia induced by an almost occluded PDA, which probably masked other symptoms induced by the other partially narrowed coronary vessels.

CONCLUSION

The diagnosis of angina pectoris by the nature of resultant pain or discomfort is unreliable. While a number of associated symptoms, particularly belching, do have a higher predictive value, our report reinforces the need for a good history taking and earlier objective electrocardiographic information to prevent cardiac muscle damage and even death.

Figure 1:

A normal ECG record for the Patient during rest

Can Gas Cause Chest Pain?

When it’s trapped in your upper abdomen, backed-up intestinal gas can cause intense chest pain. In fact, some people may wonder if they’re having a heart attack and not just needing to fart.

Fortunately, while chest pain can signal a real emergency, there are ways to tell the difference, as well as options for finding relief.

Gastroenterologist Christine Lee, MD, offers some guidance.

How can gas make my chest hurt?

On the long and winding road that is your digestive system, there are only two spots where gas can get out. When it sneaks out of the southern port, we call it a fart. When it heads up north, that’s a burp or a belch.

It’s all part of the digestive process, and it generally proceeds without much fuss.

But that’s not always the case. Sometimes, that gas gets trapped, says Dr. Lee, “And if, for whatever reason, you haven’t been able to pass it from below, it can travel north and end up as chest discomfort.”

What does gas-induced chest pain feel like?

Every person’s experience of pain can be different, notes Dr. Lee. That makes it hard to say with certainty how gas pain might feel to you.

With that warning in mind, common signs of gas accumulation in your chest might include:

• A feeling of pressure or tightness on either the left or the right side of your chest.
• Sharp, jabbing pain in your chest or upper abdomen.
• Swelling or bloating in your abdomen.
• Voluntary or involuntary farting and/or belching.

Most times, gas pains occur in response to something you ate or drank, like:

• Carbonated drinks, like beer or soda.
• Foods you’re sensitive to, like dairy products or gluten.
• Foods that are high in fiber, including fiber supplements.
• Excessive amounts of swallowed air, which might have happened while you ate, smoked, talked, chewed gum, drank through a straw or sucked on hard candies.
• Medications, including statins, nonsteroidal anti-inflammatory drugs and some laxatives.
• Artificial sweeteners.
• Food poisoning, especially if the gas pain is accompanied by fever, nausea, vomiting or diarrhea.

Other potential causes of gas pains include medical conditions like:

• Gallbladder disease.
• Acid reflux.
• Heartburn.
• Irritable bowel syndrome (IBS).
• Indigestion.
• Celiac disease.
• Delayed stomach emptying (gastroparesis).
• SIBO (small bowel bacterial overgrowth).
• Obstruction or blockage of the digestive tract, which might be caused by conditions such as colorectal, ovarian or stomach cancers.

How can I tell if it’s gas pain or a heart attack?

Most times, chest pains caused by gas from something you ate or drank occur post eating or drinking, and burping or farting bring immediate relief.

A heart attack, on the other hand, is a lot more serious. But, again, because everyone experiences pain differently, it can be very hard to tell the difference between the two.

Here are some of the “early warning” signs of a heart attack — but beware: Heart attack signs can vary widely, from crushing pain to no pain at all:

• Pressure or tightness in your chest.
• Pain in your arm, jaw, neck or back.
• Cold sweats.
• Heartburn or indigestion.
• Shortness of breath.
• Nausea or vomiting.
• Unusual fatigue.
• Exertional in nature

If you think you might be having a heart attack, call 911 for immediate medical attention.

In fact, any time you experience chest pain, states Dr. Lee, caution must prevail. “I can give you the textbook description of a heart attack, but unfortunately, that’s not always the norm. Some people have no pain with a heart attack. Others, say, might just feel a tingling in their left arm.

“So, if a cardiology textbook can’t explain chest pain for everyone, there is no way to explain gas pain for everyone — because what feels like gas pain to one person might feel like a heart attack to another.”

How can I get rid of the gas trapped in my chest?

The most direct way to relieve trapped gas is to let it out, by way of burping or farting.

Try one or more of these tips to encourage the gas to move on:

• Gentle exercise, including walking or yoga, can relax your gut and help move the gas through your digestive system.
• Pooping (or having a bowel movement) can help dispel intestinal gas.
• Ginger has been shown to prevent bloating and gas. Try eating a piece of candied ginger, drinking a cup of ginger tea or even drinking some warm water with a sprinkling of powdered ginger on top.
• Apply a heating pad or hot water bottle to your tummy to help relax your gut.
• Try a gentle abdominal self-massage.
• If your healthcare provider agrees, try an over-the-counter remedy containing simethicone, which is found in several popular stomach medications.
• Avoid medications that slow down your gut (like narcotics, pain medications and some allergy medications).

Tips for reducing future ‘gas attacks’

To reduce the chances of excess gas buildup and future bouts of gas pain, consider these tips:

• Reduce the amount of hard-to-digest foods in your diet. That might mean reducing portion sizes or limiting how often you eat things like beans, Brussels sprouts, broccoli, cabbage, onions, garlic, dairy products and foods containing artificial sweeteners.
• Reduce the number of carbonated beverages in your diet, including carbonated water, soda and beer.
• If you know you can’t tolerate foods containing lactose or gluten, try to eliminate them from your diet. A dietitian or other healthcare provider can help.
• Minimize the air you swallow by avoiding the use of drinking straws, eliminating smoking, limiting chewing gum and reducing how much you talk while you eat.
• Review your medications with your doctor if you think they may be contributing to your gas.
• Stay hydrated and move your bowels regularly to limit the buildup of gas-producing bacteria.
• Exercise regularly and avoid prolonged sitting to keep your digestive tract moving smoothly.

When to see a healthcare provider

Dr. Lee says it comes down to this: “Prevention is always easier than treatment.”

Whether your chest pain is a sign of heart disease, the result of colorectal cancer or just because you ate too much broccoli, she recommends a prompt conversation with your healthcare provider.

“I’m very conservative,” she continues, “but the sooner you get a diagnosis for what’s causing your pain, the more options you have. The earlier the diagnosis, the easier it is to treat, or even to cure, the problem. But if you wait too long, you might no longer be able to cure it — you might just have to concentrate on not letting things get worse.”