Chest Pain After Eating

What Type of Chest Pain?

Chest pain can occur anywhere within the upper body. Chest pain can feel different depending on the cause and the individual. It may be described as sharp, dull, burning, aching, stabbing or a crushing sensation. 

Common Causes of Your Chest Pain

Your chest pain can be due to a single cause or a combination of different causes which can include:

• Heartburn or indigestion, where some individuals may feel a burning sensation after eating, feeling bloated, or food brought back up to the throat 
• Strain in the chest after chest injuries
• Anxiety that can be triggered by a stressful situation, leading to a fast heartbeat and dizziness
• Chest infections which makes it difficult for a person to breathe properly and can lead to fever and mucus secretion in the airway (for eg. yellow or green mucus can be expectorated by individuals with pneumonia)
• Pericarditis, characterised by a a sharp, stabbing pain that can happen suddenly and get worse as you breathe deeply or lie down
• Heart attack or Angina have similar symptoms to heartburn but a heart attack is more life- threatening. ³

Is my Chest Pain due to Heartburn or a Heart Attack?

What is heartburn?

Heartburn is defined as a burning sensation in your chest caused by stomach acid moving towards the throat (acid reflux) and chronic heartburn can be indicative of gastroesophageal reflux disease (GERD).¹ The symptoms of heartburn and heart attack are difficult to differentiate, hence it is important to go to the emergency room to rule out heart attack.

Signs that are more likely to occur with a heart attack are; tightness in the chest, shortness of breath, lightheadedness, cold, sweat and fatigue. 

Heartburn symptoms can include: 

• Sour taste in your mouth 
• Small amounts of stomach contents rising in the back of the throat
• Sleep disturbances 
• Discomfort occurring after eating meals or while lying down 
• Burning sensation in the chest involving the upper abdomen² 

When to Seek Urgent Medical Help

If you are experiencing persistent chest pain and not sure if it is heartburn, call 999 or 111 to explain you had an episode of unexplained chest pain which went away within a few hours and you did not seek medical attention for. 

If you experience sudden chest pain that:

• Has spread to your arms, neck, jaw or back.
• Makes your chest feel tight or heavy 
• Chest feels tight or heavy 
• Shortness of breath, sweating, feeling or being sick 
• Lasts more than 15 minutes

You may be having a heart attack. Call 999 and seek immediate treatment in a hospital.³

Causes of Chest Pain after Eating

Non-cardiac Chest Pain

Non-cardiac chest pain is a chronic condition when there is recurrent angina pectoris-like pain (chest pain caused by reduced blood flow to the heart muscles due to coronary heart disease) without the evidence of coronary heart disease in the diagnostic evaluation⁴.

The burning sensation in the chest which occurs after consuming heavy meals is usually suggestive of heartburn instead of non-cardiac chest pain. If you have just eaten a big meal and feeling a burning sensation in your chest it might be heartburn.⁵

What causes Non-Cardiac Chest Pain?

There is no direct cause for non-cardiac chest pain and it is subjective to the individual, can be an interaction of biological, psychological and social factors including: 

• Being overweight
• Smoking
• Aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) intake
• Neuroticism 
• Stress
• Depression and anxiety
• Gastroesophageal reflux disease (GERD) or chronic acid reflux
• Esophageal alterations such as-

1.  Esophageal muscle spasms (abnormal contractions of the esophagus)
2. Achalasia (a rare disorder which affects your lower esophageal sphincter, it doesn’t relax and open to allow for food to go into the stomach causing it to back up in the esophagus)
3. Esophageal hypersensitivity (sensory disorder where the muscles, nerves and receptors of your esophageal walls are oversensitive)
4. Inflammation of the esophagus caused by immune response to infection or food allergies (abnormal esophageal tissues creates constrictions such as rings or webs)^1,4,5

Diagnosis

The clinician will measure heart rates, blood pressure and screen for heart attack or any heart diseases. They will also record medical history and account for factors such as stress. Once the cardiac factors are ruled out, the patient will be referred to a gastroenterologist. They will check the esophagus for signs of GERD. Drugs such as proton pump inhibitors are effective as it inhibits the excess production of acid in the stomach. Some of the diagnostic tests are esophageal pH test, esophageal motility test, upper endoscopy or ultrasound.⁵

Treatment

Early diagnosis and effective treatment is crucial. Acid reflux can be treated using PPIs which reduce the amount of stomach acid, allowing ulcers and acidic corrosion to heal.  It is 90% effective in treating GERD and its side effects. Treatments start with a high dosage to control symptoms, after which the dosage is lowered for two to four months. ⁵

Pain blockers

A common and effective treatment is medicine that blocks the pain signals. Tricyclic antidepressants (TCS) block pain signals if used in low doses.

Emotional and behavioral therapies

Depression, anxiety or stress can be related to NCCP. Stress management through exercise, meditation and relaxation can help. Cognitive behavioral therapy can teach you how to change your thought processes. Psychotherapy can help work through problems to reduce the occurrence of chest pain. ⁵

Conclusion

Chest pain can occur after eating a big meal, presenting as a burning sensation due to acid reflux. However, there is no singular cause for chest pain or non-cardiac chest pain as it can be due to an interaction of social, psychological and biological factors. Chest pain due to this reason can be confused for a heart attack, however if you are not sure, immediately go to the emergency room to rule this out. If non-cardiac chest pain or acid reflux is recurrent you can be prescribed medication, therapies and a proton- pump inhibitor.