CARDIOSPASM - Watsons Health
CARDIOSPASM - WatsonsHealth

CARDIOSPASM

Cardiospasm occurs when there is no relaxation of certain muscle fibers. As the smooth muscle fibers fail to relax, a sphincter cannot open when needed and remains closed.

Regurgitation, difficulty in swallowing and chest pain, in some cases, are the common signs of cardiospasm.

Symptoms appear similar to hiatus hernia, gastroesophageal reflux disease (GERD), even psychosomatic disorders. Special tests such as barium swallow test, esophageal manometry and radiography are used to diagnose cardiospasm.

The major symptoms of cardiospasm are listed below:

  • Dysphagia
  • Regurgitation of undigested food
  • Weight loss
  • Chest pain behind the sternum

Patients will experience difficulty in swallowing that worsens gradually. They may have cough while lying down horizontally.

Chest pain due to cardiospasm might be mistaken as a heart attack. It will be highly difficult for the patients to swallow foods, fluids and even saliva.  The retained saliva may reach lungs through aspiration.

DIAGNOSIS

Common diagnostic tests for cardiospasm are esophageal manometry and barium swallow test.

Barium swallow. The patient has to swallow a barium solution and the movement of fluid will be recorded with fluoroscopy.

If the person suffers from cardiospasm, narrowed gastro-esophageal junction will be seen a rat’s tail or bird’s beak appearance.

Esophageal manometry. A thin tube will be inserted through the nostrils and the patient has to swallow many times. This test estimates the amount of muscle movements in the various points of the esophagus while swallowing.

This shows the failure of the lower esophageal sphincter to relax during swallowing and the absence of functional peristalsis in the smooth muscle fibers.

Biopsy. It is not performed typically for diagnosing cardiospasm. This procedure involves the removal of small portion of tissue during endoscopy.

 

TREATMENT

Lifestyle changes

Patients have to chew more, eat slowly, and drink more water while they eat. It is recommended not to eat before bedtime.

Avoiding foods that trigger reflux and taking proton pump inhibitors will help in reducing the regurgitation.

Medication

Medicines like calcium channel blockers (nifedipine) and nitrates (isosorbide dinitrate and nitroglycerin) that can decrease LES pressure are helpful.

Botulinum toxin (Botox) can be injected into the LES to paralyze the muscles keeping it closed.

Pneumatic dilatation

In this method the muscle fibers are expanded and slightly torn by the strong inflation of a balloon inserted inside the LES.

Pneumatic dilatation is highly effective on people who are aged above 40. For younger patients, the results are short-lived.

Surgery

This laparoscopic surgery is the most effective and about 90% of cardiospasm patients are benefitted by this treatment.

The procedure involves a small cut on the outer layer of esophagus above the LES and extends up to stomach.

Endoscopic myotomy

Per-oral endoscopic myotomy or POEM is an advanced minimally invasive endoscopic surgery that is similar to the Heller myotomy.

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