What is esophageal spasm

Esophageal spasm are painful abnormal contractions of the muscles in the esophagus (the tube that carries food from the mouth to the stomach). These spasms do not move food effectively to the stomach.

The cause of esophageal spasm is unknown. Very hot or very cold foods may trigger an episode in some people.

Nitroglycerin given under the tongue (sublingual) may help a sudden episode of esophageal spasm. Long-acting nitroglycerin and calcium channel blockers are also used for the problem.

What does an esophageal spasm feel like

• Difficulty swallowing or pain with swallowing
• Pain in the chest or upper abdomen

Esophageal spasms can feel like sudden, severe chest pain that lasts from a few minutes to hours. It can be hard to tell a esophageal spasm from angina pectoris (a symptom of heart disease) or a heart attack (myocardial infarction). The pain may spread to the neck, jaw, arms, or back.

An esophageal spasm may come and go (intermittent) or last for a long time (chronic). But sometimes the spasms are frequent and can prevent food and liquids from traveling through the esophagus. If esophageal spasms interfere with your ability to eat or drink, medicine can help relieve symptoms.

Figure 1. Esophagus

Esophageal spasm or Heart attack

A heart attack happens when the flow of oxygen-rich blood to a section of heart muscle suddenly becomes blocked and the heart can’t get oxygen. If blood flow isn’t restored quickly, the section of heart muscle begins to die ¹. Every 40 seconds, someone in the United States has a heart attack ².

The most common warning symptoms of a heart attack for both men and women are:

• Chest pain or discomfort. Most heart attacks involve discomfort in the center or left side of the chest. The discomfort usually lasts for more than a few minutes or goes away and comes back. It can feel like pressure, squeezing, fullness, or pain. It also can feel like heartburn or indigestion. The feeling can be mild or severe.
• Upper body discomfort. You may feel pain or discomfort in one or both arms, the back, shoulders, neck, jaw, or upper part of the stomach (above the belly button).
• Shortness of breath. This may be your only symptom, or it may occur before or along with chest pain or discomfort. It can occur when you are resting or doing a little bit of physical activity.

Not everyone having a heart attack has typical symptoms. If you’ve already had a heart attack, your symptoms may not be the same for another one. However, some people may have a pattern of symptoms that recur.

Many people aren’t sure what’s wrong when they are having symptoms of a heart attack.

Not all heart attacks begin with the sudden, crushing chest pain that often is shown on TV or in the movies. In one study, for example, one-third of the patients who had heart attacks had no chest pain ³. These patients were more likely to be older, female, or diabetic.

The symptoms of a heart attack can vary from person to person. Some people can have few symptoms and are surprised to learn they’ve had a heart attack. If you’ve already had a heart attack, your symptoms may not be the same for another one. It is important for you to know the most common symptoms of a heart attack and also remember these facts:

• Heart attacks can start slowly and cause only mild pain or discomfort. Symptoms can be mild or more intense and sudden. Symptoms also may come and go over several hours.
• People who have high blood sugar (diabetes) may have no symptoms or very mild ones.
• The most common symptom, in both men and women, is chest pain or discomfort.
• Women are somewhat more likely to have shortness of breath, nausea and vomiting, unusual tiredness (sometimes for days), and pain in the back, shoulders, and jaw.

The more signs and symptoms you have, the more likely it is that you’re having a heart attack.

Other Common Signs and Symptoms include:

• Breaking out in a cold sweat
• Feeling unusually tired for no reason, sometimes for days (especially if you are a woman)
• Nausea (feeling sick to the stomach) and vomiting
• Light-headedness or sudden dizziness
• Any sudden, new symptom or a change in the pattern of symptoms you already have (for example, if your symptoms become stronger or last longer than usual)

The symptoms of angina can be similar to the symptoms of a heart attack. Angina is chest pain that occurs in people who have coronary heart disease, usually when they’re active. Angina pain usually lasts for only a few minutes and goes away with rest.

Chest pain or discomfort that doesn’t go away or changes from its usual pattern (for example, occurs more often or while you’re resting) can be a sign of a heart attack.

• All chest pain should be checked by a doctor.

The signs and symptoms of a heart attack can develop suddenly. However, they also can develop slowly—sometimes within hours, days, or weeks of a heart attack.

Any time you think you might be having heart attack symptoms or a heart attack, don’t ignore it or feel embarrassed to call for help. Call your local emergency number for emergency medical care, even if you are not sure whether you’re having a heart attack. Here’s why:

• Acting fast can save your life.
• An ambulance is the best and safest way to get to the hospital. Emergency medical services personnel can check how you are doing and start life-saving medicines and other treatments right away. People who arrive by ambulance often receive faster treatment at the hospital.
• The emergency phone operator or EMS technician can give you advice. You might be told to crush or chew an aspirin if you’re not allergic, unless there is a medical reason for you not to take one. Aspirin taken during a heart attack can limit the damage to your heart and save your life.

Every minute matters. Never delay calling your local emergency number in order to take aspirin or do anything else you think might help.

Heart attack treatment works best when it’s given right after symptoms occur.

• Don’t Wait–Get Help Quickly
• Quick Action Can Save Your Life
• If you think you or someone else is having a heart attack, even if you’re not sure, don’t feel embarrassed to call your local emergency number right away !
• Do not drive to the hospital or let someone else drive you. Call an ambulance so that medical personnel can begin life-saving treatment on the way to the emergency room. Take a nitroglycerin pill if your doctor has prescribed this type of treatment.

Other Names for a Heart Attack

• Myocardial infarction (MI)
• Acute myocardial infarction (AMI)
• Acute coronary syndrome
• Coronary thrombosis
• Coronary occlusion

Every year, about 790,000 Americans have a heart attack. Of these cases

• 580,000 are a first heart attack.
• 210,000 happen to people who have already had a first heart attack ².
• About 15% of people who have a heart attack will die from it ².
• Almost half of sudden cardiac deaths happen outside a hospital ⁴.
• One of 5 heart attacks is silent—the damage is done, but the person is not aware of it ².

Heart attacks most often occur as a result of coronary heart disease (CHD), also called coronary artery disease. Coronary heart disease is a condition in which a waxy substance called plaque (cholesterol plaque) builds up inside the coronary arteries. These arteries supply oxygen-rich blood to your heart.

When plaque builds up in the arteries, the condition is called atherosclerosis. The buildup of plaque occurs over many years.

Eventually, an area of plaque can rupture (break open) inside of an artery. This causes a blood clot to form on the plaque’s surface. If the clot becomes large enough, it can mostly or completely block blood flow through a coronary artery.

If the blockage isn’t treated quickly, the portion of heart muscle fed by the artery begins to die. Healthy heart tissue is replaced with scar tissue. This heart damage may not be obvious, or it may cause severe or long-lasting problems.

Figure 2. Heart With Muscle Damage and a Blocked Artery

A less common cause of heart attack is a severe spasm (tightening) of a coronary artery. The spasm cuts off blood flow through the artery. Spasms can occur in coronary arteries that aren’t affected by atherosclerosis.

Heart attacks can be associated with or lead to severe health problems, such as heart failure and life-threatening arrhythmias.

Heart failure is a condition in which the heart can’t pump enough blood to meet the body’s needs. Arrhythmias are irregular heartbeats. Ventricular fibrillation is a life-threatening arrhythmia that can cause death if not treated right away.

Esophageal spasm causes

It’s not clear what causes esophageal spasms. However, they appear to be related to abnormal functioning of nerves that control the muscles you use when you swallow.

A healthy esophagus normally moves food into your stomach through a series of coordinated muscle contractions. Esophageal spasms make it difficult for the muscles in the walls of your lower esophagus to coordinate in order to move food to your stomach.

There are two types of esophageal spasms:

• Occasional contractions (diffuse esophageal spasms). This type of spasm may be painful and is often accompanied by regurgitation of food or liquids.
• Painfully strong contractions (nutcracker esophagus). Although painful, this type of spasm — also referred to as jackhammer esophagus — may not cause regurgitation of food or liquids.

Risk factors for esophageal spasm

Esophageal spasms are a rare condition. They tend to occur in people between the ages of 60 and 80, and may be associated with gastroesophageal reflux disease (GERD).

Other factors that can increase the risk of esophageal spasms include:

• High blood pressure
• Anxiety or depression
• Drinking red wine or consuming very hot or very cold foods or drinks.

Esophageal spasm prevention

Avoid very hot or very cold foods if you get esophageal spasms.

Esophageal spasm symptoms

Signs and symptoms of esophageal spasms include:

• Squeezing pain in your chest. The pain is often intense, and you might mistake it for heart pain (angina).
• Difficulty swallowing, sometimes related to swallowing specific substances, such as red wine or extremely hot or cold liquids.
• The feeling that an object is stuck in your throat.
• The return of food and liquids back up your esophagus (regurgitation).

Esophageal spasm diagnosis

Your doctor might recommend:

• Endoscopy. A flexible tube (endoscope) that is passed down your throat allows your doctor to see the inside of the esophagus. Your doctor may remove a tissue sample (biopsy) for testing to rule out other esophageal diseases.
• X-ray. Images of your esophagus are taken after you swallow a contrast liquid.
• Esophageal manometry. This test measures muscle contractions in your esophagus when you swallow water
• Esophageal pH monitoring. This test can determine if stomach acid is flowing back into your esophagus (acid reflux).

Esophageal spasm treatment

Treatment depends on the frequency and severity of your esophageal spasms.

If your esophageal spasms are occasional, your doctor might recommend avoiding trigger foods or situations.

If your esophageal spasms make it difficult to eat or drink, your doctor might recommend:

Managing any underlying conditions

Esophageal spasms are sometimes associated with conditions such as heartburn, GERD, anxiety or depression. Your doctor might recommend a proton pump inhibitor — such as lansoprazole — to treat GERD, or an antidepressant, such as trazodone or imipramine (Tofranil). Antidepressants might also help reduce the sensation of pain in the esophagus.

Esophageal spasm medication to relax your swallowing muscles

Nitroglycerin given under the tongue (sublingual) may help a sudden episode of esophageal spasm. Long-acting nitroglycerin and calcium channel blockers are also used for the problem.

Long-term (chronic) cases are sometimes treated with low-dose antidepressants such as trazodone or nortriptyline to reduce symptoms.

Sildenafil (Revatio, Viagra), onobotulinumtoxin A (Botox) injections or calcium channel blockers, such as diltiazem (Cardizem CD, Tiazac, others), can also reduce the severity of esophageal spasms.

Surgery (myotomy)

If medication doesn’t work, your doctor might recommend a procedure that involves cutting the muscle at the lower end of the esophagus, to weaken esophageal contractions. Long-term studies of this approach aren’t available, so myotomy generally isn’t recommended for esophageal spasms. However, it might be considered if other treatments don’t work.

Peroral endoscopic myotomy (POEM)

In this new minimally invasive technique, an endoscope inserted through your mouth and down your throat allows an incision in the inside lining of your esophagus. Then, as in myotomy, the surgeon cuts the muscle at the lower end of the esophagus. Like myotomy, POEM is usually considered only if other treatments don’t work.

Esophageal spasm treatment diet

To help you cope with occasional esophageal spasms, try to:

• Avoid your triggers. Make a list of foods and beverages that cause your esophageal spasms.
• Choose food that is warm or cool. Let foods and drinks that are very hot or very cold sit for a bit before eating or drinking them.
• Find ways to control stress. Esophageal spasms may be more common or more severe when you’re stressed.
• Suck a peppermint lozenge. Peppermint oil is a smooth-muscle relaxant and might help ease esophageal spasms. Place the peppermint lozenge under your tongue.

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3. National Institutes of Health. National Heart, Lung and Blood Institute. What Are the Symptoms of a Heart Attack ? https://www.nhlbi.nih.gov/health/health-topics/topics/heartattack/signs[↩]
4. Zheng ZJ, Croft JB, Giles WH, Ayala CI, Greenlund KJ, Keenan NL, Neff L, Wattigney WA, Mensah GA. State Specific Mortality from Sudden Cardiac Death: United States, 1999. MMWR 2002;51(6):123–126. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5106a3.htm[↩]