Heartburn may be very severe, but can usually be identified by several characteristics. It often becomes much worse soon after eating; it is sometimes relieved by standing up; it is frequently made worse by bending forward or by lying down. Heartburn is suddenly relieved with a drink of soda water, or sometimes even plain water, and this miraculously sudden relief is felt because the irritating acid in the esophagus was washed down into the stomach again.
This is a very common chest pain, and is often thought to be


Fig. 68. The name heartburn is misleading. The burning pain has nothing to do with the heart, but is felt in the area thought of as the “heart.” The source of “heartburn” pain is the swallowing tube (esophagus) which is “burned” by stomach acids washing upward toward the mouth. These stomach acids irritate the esophagus, causing intense pain. The patient may fear a heart attack, but is relieved when the acid is washed down with water, soda or milk.

coming from the heart. But when it has been present for a while, a person usually thinks of it as his “indigestion.” There is only one real danger here. When a person who has been accustomed to the pain of heartburn, really does have some heart difficulty, he is likely to confuse the two and to regard the real heart pain also as “indigestion.”

Pain in the chest may have its cause in the abdomen. These pains are relatively uncommon and are usually identified by the fact that they occur the same time after meals, or after certain types of food. The stomach, gallbladder, pancreas and some difficulties of the colon (discussed in another chapter) occasionally cause chest pain. It may take a careful physical examination on the part of the physician, to reveal the source of the pain, which will eventually be found to be outside of the chest itself.

As in all parts of the body, chest pain may be more imagined than real. This type of pain occurs in a group of people who have hypnotized themselves to think that they have heart trouble. Many explanations for this type of “heart trouble,” eventually come to be regarded as a lazy person’s excuse for his


Fig. 69. Heart pain varies greatly in intensity and duration. Its location, however, follows a fairly typical pattern involving the left chest, neck and inner surface of the left arm.

unwillingness to work, or to explain his failure at a certain work. Most of these people with imagined chest pain, who complain of heart disease for years, have had several good doctors tell them, that there is nothing wrong. However, the patient fears losing his good excuse (heart disease), above anything else, and therefore, the complaint goes on and on. These people rarely die of heart disease, but it may take a physician skilled in psychiatry to uncover this patient’s problem.

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