Chest pain

Chest pain related Treatments and drugs

to cardiac problems
Cardiac causes
In general, chest pain If it appears that heart problems are the cause of your chest pain, your doctor
related to a heart attack or may give you medications such as:
another heart problem is
associated with one or
 Aspirin. Aspirin inhibits blood clotting, helping to maintain blood flow
more of the following:
through narrowed heart arteries. When taken during a heart attack, aspirin can
significantly decrease death rates. You may be asked to chew the aspirin to
1. Pressure, fullness hasten its absorption. Aspirin is recommended for most people who have had a
or tightness in heart attack.
your chest
 Nitroglycerin. This medication for treating angina temporarily widens
2. Crushing or narrowed blood vessels, improving blood flow to and from your heart.
searing pain that
radiates to your  Beta blockers. These drugs help relax your heart muscle, slow your
back, neck, jaw, heart rate and decrease your blood pressure, which decreases the demand on
your heart. These medications help limit the amount of damage during a heart
shoulders and
attack and prevent a second heart attack.
arms, especially
your left arm
 Thrombolytics. These drugs, also called clotbusters, help dissolve a
blood clot that's blocking blood flow to your heart. These drugs are most
3. Pain that lasts
effective when taken within an hour after symptoms of a heart attack begin.
more than a few
minutes, goes  Ranolazine (Ranexa). This is a relatively new drug for treating
away and comes chronic angina. It's used only when other anti-anginal drugs haven't worked
back or varies in because it can cause a heart problem known as QT prolongation, which can
intensity increase your risk of heart rhythm problems. It should be used with other
angina medications, such as calcium channel blockers, beta blockers or
4. Shortness of nitroglycerin.
breath, sweating,
dizziness or  Angiotensin-converting enzyme (ACE) inhibitors and
nausea angiotensin receptor blockers (ARBs). These drugs allow blood to
flow from your heart more easily. Your doctor may prescribe ACE inhibitors or
ARBs if you've had a moderate to severe heart attack that has reduced your
heart's pumping capacity. These drugs also lower blood pressure and may
prevent a second heart attack.
Chest pain related
to noncardiac  Calcium channel blockers. When treating coronary artery spasm,
problems doctors sometimes use heart medications such as calcium channel blockers to
Chest pain that isn't related relax the coronary arteries and prevent spasm.
to a heart problem is more
often associated with:
Heart attack treatments
If it's clear you're having a heart attack, you may be treated with clotbusting
1. A burning sensation drugs or undergo a surgical procedure such as:
behind your
breastbone
 Angioplasty and stenting. During an angioplasty — also called a
(sternum)

1
2. A sour taste or a percutaneous coronary intervention (PCI) — doctors insert a catheter with a
sensation of food special balloon into a blocked coronary artery. The balloon is inflated to open up
re-entering your the artery and restore blood flow to your heart. Then, a small wire mesh coil
mouth (stent) is usually inserted to keep the artery open. Many people will go straight
from the emergency room to the catheterization laboratory to have angioplasty
3. Trouble swallowing performed as quickly as possible.

4. Pain that gets  Coronary bypass surgery. This procedure creates an alternative
better or worse route for blood to go around a blocked coronary artery.
when you change
your body position Angina treatment
Doctors usually first treat angina with medication. You'll likely start receiving
5. Pain that intensifies
medication in the emergency room, including aspirin, nitroglycerin, beta blockers
when you breathe
and blood thinners.
deeply or cough

6. Tenderness when If you have unstable angina — chest pain while you're at rest — you may need
you push on your immediate coronary catheterization followed by angioplasty and stenting. In some
chest cases, you may need coronary bypass surgery.

Treatment for other cardiovascular

conditions
Other heart and lung conditions can be treated initially in the emergency room. If
it's clear you're experiencing a pulmonary embolism, you'll likely be treated with
emergency blood-thinning medications, sometimes including clotbusting
medications (thrombolytics).

Aortic dissection often requires emergency surgery.

Noncardiac causes
If emergency room doctors determine you're out of immediate danger, you may
be referred to your own physician or a specialist for further evaluation.
Treatments for noncardiac causes of chest pain depend on the type of problem.
These problems and their treatments include:

 Heartburn. If your symptoms suggest heartburn, you'll likely need to

take an over-the-counter or prescription-strength stomach acid blocker or
antacid in the emergency room. Most episodes of heartburn are isolated events
caused by overeating or by eating fatty foods.

If you experience frequent heartburn (at least one episode a week), your doctor
or a doctor who specializes in stomach and intestinal problems
(gastroenterologist) may ask you to undergo more tests. Left untreated, chronic,
frequent heartburn can occasionally lead to scarring and narrowing of your
esophagus. Treatment for chronic heartburn may include dietary modifications,
antacids, acid blockers or other prescription medications and, in some cases,

2
 surgery.

 Panic attack. This anxiety-related cause of chest pain can be treated

with prescription anti-anxiety medications, relaxation techniques and counseling
to find out what may be triggering your attacks. Panic attacks are often
mistaken for heart attacks, and many people are seen in emergency rooms for
this problem. But once your condition is diagnosed, you can be referred for
treatment to help you gain control over these attacks.

 Pleurisy. This inflammation of the pleura, the membrane that lines

your chest cavity and covers your lungs, may result from a variety of
conditions, including pneumonia and, rarely, autoimmune conditions such as
lupus. Your doctor will want to identify and treat the underlying disease that
caused pleurisy. Over-the-counter pain relievers can help minimize the pain
until the inflammation subsides.

 Costochondritis. Treatment for this inflammation of the cartilage of

your rib cage is generally rest, heat and nonsteroidal anti-inflammatory drugs,
such as ibuprofen (Advil, Motrin, others).

 Sore muscles, injured ribs or pinched nerves. Chest pain

from injured ribs, pinched nerves and sore chest muscles improves with time
and self-care measures recommended by your doctor.

 Swallowing disorders. These disorders have many causes, which can

usually be treated with medications, minor surgery or endoscopic techniques.
You'll probably be referred to a gastroenterologist for evaluation and treatment.

 Shingles. Treatment with acyclovir (Zovirax) or a similar antiviral

medication is best started as quickly as possible, preferably within 24 hours
from the onset of pain or burning, and before the appearance of blisters.
Doctors use other treatments, such as analgesics and antihistamines, to control
symptoms such as pain and itching.

 Gallbladder or pancreas problems. You may need surgery to

treat an inflamed gallbladder or pancreas that's causing pain to radiate from
your abdomen into your chest.

Chest pain can be one of the most difficult symptoms to interpret. But spending
time in the ER having your chest pain evaluated can bring you peace of mind, and
may even save your

Chest pain
3
Definition
Chest pain can come on suddenly at any time. You try to ignore it at first, but your chest pain has you scared and
worried. Could you be having a heart attack? Should you go to the emergency room (ER)?

Chest pain is one of the most common reasons people call for emergency medical help. Every year emergency room
doctors evaluate and treat millions of people for chest pain.

Fortunately, chest pain doesn't always signal a heart attack. Often chest pain is unrelated to any heart problem. But
even if the chest pain you experience has nothing to do with your cardiovascular system, the problem may still be
important — and worth the time spent in an emergency room for evaluation.

Symptoms
A wide range of health problems can cause chest pain. In many cases, the underlying cause has nothing to do with
your heart — though there's no easy way to tell without seeing a doctor.

Chest pain related to cardiac problems

In general, chest pain related to a heart attack or another heart problem is associated with one or more of the
following:

5. Pressure, fullness or tightness in your chest

6. Crushing or searing pain that radiates to your back, neck, jaw, shoulders and arms, especially your
left arm

7. Pain that lasts more than a few minutes, goes away and comes back or varies in intensity

8. Shortness of breath, sweating, dizziness or nausea

Chest pain related to noncardiac problems

Chest pain that isn't related to a heart problem is more often associated with:

7. A burning sensation behind your breastbone (sternum)

8. A sour taste or a sensation of food re-entering your mouth

9. Trouble swallowing

10. Pain that gets better or worse when you change your body position

11. Pain that intensifies when you breathe deeply or cough

12. Tenderness when you push on your chest

4
When to see a doctor
If you have new or unexplained chest pain or suspect you're having a heart attack, call for emergency medical help
immediately. Don't waste time trying to diagnose heart attack symptoms yourself.

Every minute is crucial if you're having a heart attack. A trip to the emergency room could save your life — or bring
you peace of mind if nothing is seriously wrong with your health.

Don't drive yourself to the hospital, unless you have no other option. Driving yourself puts you and others at risk if
your condition suddenly worsens.

Causes
Chest pain

Chest pain isn't always caused by heart problems. But, because you can't always determine the cause yourself, don't
delay in seeking medical attention.
Chest pain has many possible causes, all of which deserve medical attention.

5
Cardiac causes

 Heart attack. A heart attack is a result of a blood clot that's blocking blood flow to your heart muscle.

 Angina. Hard, thick, cholesterol-containing plaques can gradually build up on the inner walls of the arteries
that carry blood to your heart. These plaques temporarily narrow the arteries and restrict the heart's blood supply,
particularly during exertion. Restricted blood flow to your heart can cause recurrent episodes of chest pain —
angina pectoris, or angina (pronounced an-JI-nuh or AN-juh-nuh).

 Aortic dissection. This life-threatening condition involves the main artery leading from your heart —
your aorta. If the inner layers of this blood vessel separate, forcing blood flow between them, the result is sudden
and tearing chest and back pain. Aortic dissection can result from a sharp blow to your chest or develop as a
complication of uncontrolled high blood pressure.

6
  Coronary spasm. In coronary spasm, which is sometimes called Prinzmetal's angina, arteries that
supply blood to the heart go into spasm, temporarily stopping blood flow. It occurs at rest and may coexist with
coronary artery disease — a buildup of plaques in the coronary arteries.

 Pericarditis. This condition, an inflammation of the sac surrounding your heart, is short-lived and often
related to a viral infection.

 Other heart-related conditions. Other heart problems — such as myocarditis, an inflammation

of the heart that often is caused by viral infection — can cause chest pain. Certain types of heart muscle disorders,
such as hypertrophic cardiomyopathy, also may cause chest pain.

Digestive causes

 Heartburn. Stomach acid that washes up from your stomach into the tube (esophagus) that runs from
your throat to your stomach can cause heartburn — a painful, burning sensation behind your breastbone (sternum).

 Esophageal spasm. Disorders of the esophagus, the tube that runs from your throat to your stomach,
can make swallowing difficult and even painful. One type is esophageal spasm, a condition that affects a small
group of people with chest pain. When people with this condition swallow, the muscles that normally move food
down the esophagus are uncoordinated. This results in painful muscle spasms.

 Hiatal hernia. In this condition, part of the stomach slides up above the diaphragm into the chest. This
can cause chest pressure or pain, particularly after eating, as well as heartburn

 Achalasia (ak-uh-LA-zhuh). In this swallowing disorder, the valve in the lower esophagus doesn't
open properly to allow food to enter your stomach. Instead, food backs up into the esophagus, causing pain.

 Gallbladder or pancreas problems. Gallstones or inflammation of your gallbladder

(cholecystitis) or pancreas can cause acute abdominal pain that radiates to your chest.

Musculoskeletal causes

 Costochondritis. In this condition — also known as Tietze syndrome — the cartilage of your rib cage,
particularly the cartilage that joins your ribs to your breastbone, becomes inflamed. The result is chest pain, often
worsened when you push on your sternum or on the ribs near your sternum.

 Sore muscles. Chronic pain syndromes, such as fibromyalgia, can produce persistent muscle-related
chest pain.

 Injured ribs or pinched nerves. A bruised or broken rib, as well as a pinched nerve, can cause
chest pain.

Respiratory causes

 Pulmonary embolism. This cause of chest pain occurs when a blood clot becomes lodged in a lung
(pulmonary) artery, blocking blood flow to lung tissue. It's rare for this life-threatening condition to occur without
preceding risk factors, such as recent surgery or immobilization.
7
  Pleurisy. This sharp, localized chest pain that's made worse when you inhale or cough occurs when the
membrane that lines your chest cavity and covers your lungs becomes inflamed. Pleurisy may result from a wide
variety of underlying conditions, including pneumonia and, rarely, autoimmune conditions, such as lupus. An
autoimmune disease is one in which your body's immune system mistakenly attacks healthy tissue.

 Other lung conditions. A collapsed lung (pneumothorax), high blood pressure in the arteries
carrying blood to the lungs (pulmonary hypertension) and asthma also can produce chest pain.

Other causes

 Panic attack. If you experience periods of intense fear accompanied by chest pain, rapid heartbeat,
rapid breathing (hyperventilation), profuse sweating and shortness of breath, you may be experiencing a panic
attack — a form of anxiety.

 Shingles. This infection of the nerves caused by the chickenpox virus can produce pain and a band of
blisters from your back around to your chest wall.

 Cancer. Rarely, cancer involving the chest or cancer that has spread from another part of the body can
cause chest pain.

Tests and diagnosis

At the emergency room or chest pain center — some large hospitals designate areas just for the evaluation of chest
pain — you'll probably have your blood pressure, pulse and temperature checked right away. In addition, the doctor
will ask a number of questions about your chest pain.

Chest pain doesn't always signal a heart attack. But that's what emergency room doctors will test for first because it's
potentially the most immediate threat to your life. They may also check for an aortic dissection or life-threatening lung
conditions — such as pulmonary embolism or a collapsed lung (pneumothorax) — that can cause chest pain.

Tests you may have to determine the cause of your chest pain include:

 Electrocardiogram (ECG). This test can help doctors diagnose a heart attack as well as other heart
problems. It records the electrical activity of your heart through electrodes attached to your skin. Heart rate and
rhythm and the electrical impulses going through your heart are recorded as waves displayed on a monitor or
printed on paper. Because injured heart muscle doesn't conduct electrical impulses normally, the ECG may show
that a heart attack has occurred or is in progress.

 Blood tests. Your doctor may order blood tests to check for increased levels of certain enzymes normally
found in heart muscle. Damage to heart cells from a heart attack may allow these enzymes to leak, over a period of
hours, into your blood.

 Chest X-ray. An X-ray of your chest allows doctors to check the condition of your lungs and the size and
shape of your heart and major blood vessels. Doctors can also use a chest X-ray to check for tumors in the chest
and to look for lung problems that can cause chest pain, such as pneumonia or pneumothorax.

8
  Stress tests. These measure how your heart and blood vessels respond to exertion, which may indicate
if your pain is related to your heart. There are many kinds of stress tests. You may be asked to walk on a treadmill
or pedal a stationary bike while hooked up to an ECG. Or you may be given a drug intravenously to stimulate your
heart in a way similar to exercise. Stress tests may be combined with imaging of the heart using ultrasound
(echocardiography) or radioactive material (nuclear scan).

 Echocardiogram. An echocardiogram uses sound waves to produce a video image of your heart. This
image can help doctors identify heart problems.

 Coronary catheterization (angiogram). This test helps doctors identify individual arteries to
your heart that may be narrowed or blocked. A liquid dye is injected into the arteries of your heart through a
catheter — a long, thin tube that's fed through an artery, usually in your groin, to arteries in your heart. As the dye
fills your arteries, they become visible on X-ray and video.

 Computerized tomography (including CT scan, CT coronary calcification scan or

CT coronary angiogram). Different types of CT scans can be used to check your heart arteries for signs of
calcium, which indicate that atherosclerotic plaques may be accumulating and blocking arteries supplying your
heart. CT scans can also be done with dye to look directly at your heart arteries.

 Magnetic resonance imaging (MRI). MRI is an imaging technique that uses magnetic fields and
radio waves to create cross-sectional images of your body. MRI of the heart is sometimes done to look for evidence
of heart damage or inflammation (myocarditis).

 Endoscopy. In this test a thin, flexible instrument attached to a camera is passed down your throat,
allowing doctors to view your esophagus and stomach and check for gastroesophageal problems that can cause
chest pain.

Many types of chest pain may at first seem related to heart problems. But often, after careful evaluation, doctors can
distinguish the symptoms of noncardiac chest pain from the pain caused by a heart condition.

Treatments and drugs

Cardiac causes
If it appears that heart problems are the cause of your chest pain, your doctor may give you medications such as:

 Aspirin. Aspirin inhibits blood clotting, helping to maintain blood flow through narrowed heart arteries.
When taken during a heart attack, aspirin can significantly decrease death rates. You may be asked to chew the
aspirin to hasten its absorption. Aspirin is recommended for most people who have had a heart attack.

 Nitroglycerin. This medication for treating angina temporarily widens narrowed blood vessels, improving
blood flow to and from your heart.

 Beta blockers. These drugs help relax your heart muscle, slow your heart rate and decrease your blood
pressure, which decreases the demand on your heart. These medications help limit the amount of damage during a
heart attack and prevent a second heart attack.

9
  Thrombolytics. These drugs, also called clotbusters, help dissolve a blood clot that's blocking blood flow
to your heart. These drugs are most effective when taken within an hour after symptoms of a heart attack begin.

 Ranolazine (Ranexa). This is a relatively new drug for treating chronic angina. It's used only when
other anti-anginal drugs haven't worked because it can cause a heart problem known as QT prolongation, which can
increase your risk of heart rhythm problems. It should be used with other angina medications, such as calcium
channel blockers, beta blockers or nitroglycerin.

 Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor

blockers (ARBs). These drugs allow blood to flow from your heart more easily. Your doctor may prescribe ACE
inhibitors or ARBs if you've had a moderate to severe heart attack that has reduced your heart's pumping capacity.
These drugs also lower blood pressure and may prevent a second heart attack.

 Calcium channel blockers. When treating coronary artery spasm, doctors sometimes use heart
medications such as calcium channel blockers to relax the coronary arteries and prevent spasm.

Heart attack treatments

If it's clear you're having a heart attack, you may be treated with clotbusting drugs or undergo a surgical procedure
such as:

 Angioplasty and stenting. During an angioplasty — also called a percutaneous coronary intervention
(PCI) — doctors insert a catheter with a special balloon into a blocked coronary artery. The balloon is inflated to
open up the artery and restore blood flow to your heart. Then, a small wire mesh coil (stent) is usually inserted to
keep the artery open. Many people will go straight from the emergency room to the catheterization laboratory to
have angioplasty performed as quickly as possible.

 Coronary bypass surgery. This procedure creates an alternative route for blood to go around a
blocked coronary artery.

Angina treatment
Doctors usually first treat angina with medication. You'll likely start receiving medication in the emergency room,
including aspirin, nitroglycerin, beta blockers and blood thinners.

If you have unstable angina — chest pain while you're at rest — you may need immediate coronary catheterization
followed by angioplasty and stenting. In some cases, you may need coronary bypass surgery.

Treatment for other cardiovascular conditions

Other heart and lung conditions can be treated initially in the emergency room. If it's clear you're experiencing a
pulmonary embolism, you'll likely be treated with emergency blood-thinning medications, sometimes including
clotbusting medications (thrombolytics).

Aortic dissection often requires emergency surgery.

Noncardiac causes
If emergency room doctors determine you're out of immediate danger, you may be referred to your own physician or
a specialist for further evaluation. Treatments for noncardiac causes of chest pain depend on the type of problem.
These problems and their treatments include:

10
  Heartburn. If your symptoms suggest heartburn, you'll likely need to take an over-the-counter or
prescription-strength stomach acid blocker or antacid in the emergency room. Most episodes of heartburn are
isolated events caused by overeating or by eating fatty foods.

If you experience frequent heartburn (at least one episode a week), your doctor or a doctor who specializes in
stomach and intestinal problems (gastroenterologist) may ask you to undergo more tests. Left untreated, chronic,
frequent heartburn can occasionally lead to scarring and narrowing of your esophagus. Treatment for chronic
heartburn may include dietary modifications, antacids, acid blockers or other prescription medications and, in some
cases, surgery.

 Panic attack. This anxiety-related cause of chest pain can be treated with prescription anti-anxiety
medications, relaxation techniques and counseling to find out what may be triggering your attacks. Panic attacks
are often mistaken for heart attacks, and many people are seen in emergency rooms for this problem. But once
your condition is diagnosed, you can be referred for treatment to help you gain control over these attacks.

 Pleurisy. This inflammation of the pleura, the membrane that lines your chest cavity and covers your
lungs, may result from a variety of conditions, including pneumonia and, rarely, autoimmune conditions such as
lupus. Your doctor will want to identify and treat the underlying disease that caused pleurisy. Over-the-counter pain
relievers can help minimize the pain until the inflammation subsides.

 Costochondritis. Treatment for this inflammation of the cartilage of your rib cage is generally rest, heat
and nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin, others).

 Sore muscles, injured ribs or pinched nerves. Chest pain from injured ribs, pinched nerves and
sore chest muscles improves with time and self-care measures recommended by your doctor.

 Swallowing disorders. These disorders have many causes, which can usually be treated with medications,
minor surgery or endoscopic techniques. You'll probably be referred to a gastroenterologist for evaluation and
treatment.

 Shingles. Treatment with acyclovir (Zovirax) or a similar antiviral medication is best started as quickly as
possible, preferably within 24 hours from the onset of pain or burning, and before the appearance of blisters.
Doctors use other treatments, such as analgesics and antihistamines, to control symptoms such as pain and itching.

 Gallbladder or pancreas problems. You may need surgery to treat an inflamed gallbladder or
pancreas that's causing pain to radiate from your abdomen into your chest.

Chest pain can be one of the most difficult symptoms to interpret. But spending time in the ER having your chest pain
evaluated can bring you peace of mind, and may even save your life.

@@@@@@@@@@@@@@@@@@@@@@@@@@@@@

Medical Treatment
Heart Attack Treatment

Treatment for a heart attack is aimed at increasing blood flow by opening arteries blocked or narrowed by a blood clot.

• Medicines used to achieve this include aspirin, heparin, and clot-busting (thrombolytic) drugs.

11
 • Other medications can be used to slow the heart rate, which decreases the workload of the heart and reduces
pain.

• Angioplasty is a way of unblocking an artery. Angiography is done first to locate narrowing or blockages. A very
thin plastic tube called a catheter is inserted into the artery. A tiny balloon on the end of the catheter is inflated. This
expands the artery, providing a wider passage for blood. The balloon is then deflated and removed. Sometimes a small
metal scaffold called a stent is placed in the artery to keep it expanded.

• Surgery may be required if medical treatment is unsuccessful. This could include angioplasty or cardiac bypass.

Angina Treatment
Treatment of angina is directed at relieving chest pain that occurs as the result of reduced blood flow to the heart.

• The medication nitroglycerin is the most widely used treatment. Nitroglycerin dilates (widens) the coronary
arteries. It is often taken under the tongue (sublingually).

• People with known angina may be treated with nitroglycerin for three doses, five minutes apart.

• If the pain remains, nitroglycerin is given by IV, and the patient is admitted to the hospital and monitored to rule
out a heart attack.

• Long-term treatment after the first episode of angina focuses on reducing risk factors for atherosclerosis and heart
disease.

Aortic Dissection Treatment

Suspected aortic dissection often is treated with medications that reduce blood pressure.

• Medications that slow the heart rate and dilate the arteries are the most widely used.

• Close monitoring is required to avoid lowering the blood pressure too much, which can be dangerous.

• Surgical repair is required for any dissection that involves the ascending (upward) portion of the aorta.

Pulmonary Embolism Treatment

Anyone with a presumed or documented pulmonary embolism requires admission to the hospital.

• Treatment usually includes supplemental oxygen and medication to prevent further clotting of blood, typically
heparin.

• If the embolism is very large, clot-busting medications are given in some situations to dissolve the clot.

• Some people undergo surgery to place an umbrella-like filter in a blood vessel to prevent blood clots from the
lower extremities from moving to the lungs.

Pneumothorax Treatment

A pneumothorax without symptoms involves six hours of hospital observation and repeat chest x-rays.

• If the size of the pneumothorax remains unchanged, the patient is usually discharged with a follow-up
appointment in 24 hours.

12
 • If the patient develop symptoms or the pneumothorax enlarges, they will be admitted to the hospital. The patient
will undergo catheter aspiration or have a chest tube inserted to restore negative pressure in the lung sac.

Perforated Viscus Treatment

Any disruption or perforation of the intestinal tract (viscus) is a potentially life-threatening emergency. Immediate surgery
may be required.

Pericarditis Treatment

Viral pericarditis usually improves with 7-21 days of therapy with nonsteroidal anti-inflammatory agents such as aspirin
and ibuprofen (for example, Motrin).

Pneumonia Treatment

Pneumonia is treated with antibiotics, and pain medication is given for chest wall tenderness.

Costochondritis Treatment

Costochondritis is usually treated with nonsteroidal anti-inflammatory medication such as ibuprofen.

Esophageal Conditions Treatment

The three major esophageal disorders that cause chest pain; 1) acid reflux (GERD), 2) esophagitis, and 3) esophageal
spasm, are treated with antacid therapy; antibiotic, antiviral, or antifungal medication; medication to relax the muscles of
the esophagus; or some combination of these.

13