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DESCRIPTION
Heartburn, also known as pyrosis, non-cardiac chest pain, and GERD (gastroesophageal reflux disease) is a burning sensation to the stomach and/or chest. It often occurs when hydrochloric acid, which is used by the stomach to digest food, backs up into the esophagus, causing sensitive tissues to become irritated. Normally the esophageal sphincter muscle pinches itself shut and prevents stomach acid from surging upward. However, if the sphincter is not functioning properly, the acid can slip past it and into the esophagus. This phenomenon is referred to as gastroesophageal reflux.
People with hiatal hernia often experience heartburn. It can also be caused by excessive consumption of spicy foods, fatty or fried foods, alcohol, coffee, citrus fruits, chocolate, or tomato-based foods. Ulcers, gallbladder problems, stress, allergies, and enzyme deficiencies are other possible contributing factors.
The early symptoms of angina and heart attack sometimes mimic those of "acid stomach." If symptoms persist, if the pain begins to travel down into the left arm, or if the sensation is accompanied by a feeling of weakness, dizziness, or shortness of breath, emergency medical help should be sought at once. See Heart Attack for more detailed information.
SIGNS & SYMPTOMS
Heartburn is a painful burning sensation in the throat (esophagus) just below the breastbone. The pain often rises in the chest and may radiate to the neck or throat.
Listed below are the symptoms for some of the most common gastrointestinal disorders. If you are experiencing any of these symptoms, seek the advice of a medical professional. This information is intended as a general reference and is not a substitute for professional medical advice or a medical exam. You should always seek the advice of your health care provider or other qualified health professional before starting any new treatment.
- Abdominal pain.
- Indigestion.
- Nausea and vomiting.
- Digestive tract gas.
- Digestive tract bleeding.
- Chest pain and burning.
- Diarrhea.
- Constipation.
Specific gastroesophageal disorder symptoms:
Gastroesophageal Reflux Disease (GERD):
- Heartburn.
- Involves a burning pain in the chest (under the breast bone).
- Increased by bending, stooping, lying down, or eating.
- Relieved by milk or antacids.
- More frequent or worse at night.
- Belching.
- Regurgitation of food.
- Nausea and vomiting.
- Vomiting blood.
- Hoarseness or change in voice.
- Sore throat.
- Difficulty swallowing.
- Cough or wheezing.
CAUSES
Heartburn is the backup of acid from the stomach into the esophagus causes irritation. Some common causes of heartburn are:
- Gastroesophageal reflux disease (GERD): GERD (also called peptic esophagus, reflux esophagus, and chronic heartburn) is when food or liquid travels from the stomach back up into the esophagus (the tube from the mouth to the stomach). This partially digested material is usually acidic and can irritate the esophagus, often causing heartburn and other symptoms. Gastroesophageal reflux is a common condition that often occurs without symptoms after meals. In some people, the reflux is related to a problem with the lower esophageal sphincter, a band of muscle fibers that usually closes off the esophagus from the stomach. If this sphincter doesn't close properly, food and liquid can move backward into the esophagus and may cause the symptoms. Some conditions are associated with incompetent esophageal sphincters, including pregnancy, hiatal hernia, obesity, recurrent or persistent vomiting and nasogastric tubes. Risk factors for reflux include previous esophageal surgery or esophageal stricture.
- Hiatal hernia occurs when the normal opening in the diaphragm (the breathing muscle that separates the thoracic cavity from the abdominal cavity) is too large. If the defect is not repaired, the stomach or other abdominal contents may bulge (herniate) into the chest, causing heartburn (gastroesophageal reflux) and serious damage to the esophagus. Hiatal hernia can be corrected through surgical repair (called fundoplication or anti-reflux surgery).
- Estrogens can weaken the esophageal hiatus muscle, which keeps stomach acids in the stomach. Women who are pregnant and women who take birth control pills that contain estrogen and progesterone are therefore more likely to suffer from heartburn.
- People with certain illnesses, such as cancer, often have excessive amounts of acid in their systems. The consumption of too much processed food and cooked food can also create an acidic environment in the body.
- Aspirin and ibuprofen can cause heartburn.
- The early symptoms of angina and heart attack sometimes mimic those of "acid stomach." If symptoms persist, if the pain begins to travel down into the left arm, or if the sensation is accompanied by a feeling of weakness, dizziness, or shortness of breath, emergency medical help should be sought at once. See Heart Attack for more information.
HEARTBURN PREVENTION
Most cases of heartburn can be prevented by following these home treatment tips.
- Change your diet and your eating habits. Avoid foods that worsen symptoms.
- Decrease pressure on your stomach.
- Avoid aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs).
- Swallow medications the right way.
- Lose weight if overweight and maintain a healthy weight.
- Stop smoking.
- Avoid alcohol.
- Avoid stress as much as possible.
TREATMENT
GENERAL MEASURES
DIAGNOSIS
Diagnostic Tests for GERD:
- A positive stool guaiac: The stool guaiac test is a test that detects the presence of hidden (occult) blood in the stool (bowel movement). The stool guaiac is the most common form of fecal occult blood test (FOBT) in use today. Brand names include: Hemoccult, hemoccult SENSA, ColoScreen, ColoScreen-ES, Seracult, and Seracult PlusŪ.
- Continuous esophageal pH monitoring showing reflux.
- Endoscopy showing ulceration or inflammation of the esophagus. An endoscope is a medical device consisting of a camera mounted on a flexible tube. Small instruments can be used to take samples of suspicious tissues through the endoscope. In gastrointestinal endoscopy, this device is inserted through the mouth or anus. For other areas, small incisions are made.
- Esophageal manometry showing abnormal sphincter pressure. Esophageal manometry is a test to measure the motor action of the lower esophageal sphincter (LES) and esophageal body. A catheter is used to measure esophageal pressure and records the duration and sequence of contractions in the esophagus.
- A barium swallow showing reflux. An Upper GI and small bowel series is a set of X-rays taken to examine the esophagus, stomach, and small intestine. X-rays are taken after the patient has swallowed a barium suspension (contrast medium). X-rays are a form of electromagnetic radiation like light, but of higher energy, so they can penetrate the body to form an image on film. Structures that are dense (such as bone) will appear white, air will be black, and other structures will be shades of gray Barium is very dense and will appear white on the X-ray film.
- A positive Bernstein test for gastric acid reflux. The Bernstein test attempts to reproduce symptoms of heartburn. It is usually done along with other tests dealing with esophageal functions.
CONVENTIONAL MEDICAL TREATMENT
GERD Treatment:
- Weight reduction.
- Avoiding lying down after meals.
- Sleeping with the head of the bed elevated.
- Taking medication with plenty of water.
- Avoiding dietary fat, chocolate, caffeine, peppermint (they may cause lower esophageal pressure).
- Avoiding alcohol and tobacco.
- Medications that alleviate symptoms include:
- Antacids after meals and at bedtime.
- Histamine H2 receptor blockers.
- Promotility agents.
- Proton pump inhibitors.
- Anti-reflux operations (Nissen fundoplication) may help a small number of patients who have persistent symptoms despite medical treatment. There are also new therapies that can be performed through an endoscope (a flexible tube passed through the mouth into the stomach) for reflux.
Prognosis: The majority of people respond to nonsurgical measures with behavioral modification and medications.
Complications:
- Inflammation of the esophagus.
- Stricture.
- Esophageal ulcer.
- Hoarseness, bronchospasm.
- Chronic pulmonary disease.
- Barrett's esophagus (a change in the lining of the esophagus that can increase the risk of cancer).
Many people treat their heartburn symptoms without seeing a health professional. There are home treatment measures, lifestyle changes, and non-prescription medications that can be useful. However, if your symptoms are not relieved by home treatment, or if your symptoms occur frequently and go on longer than 3 to 4 weeks, an evaluation by your health professional is needed to determine whether other medical conditions are causing your symptoms.
Try home treatment measures first to control your symptoms before taking non-prescription medications, such as antacids or acid reducers (histamine receptor blockers, or H2 blockers). If you take medications to relieve your heartburn without doing home treatment, your heartburn is likely to return again and again.
If you are pregnant and have heartburn symptoms, be sure to talk with your midwife or health professional about taking any heartburn medications because some medications may not be safe to take during pregnancy.
Home treatment measures:
- Change your diet and your eating habits.
- Decrease pressure on your stomach.
- Avoid aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs).
- Swallow medications the right way.
- Lose weight.
- Stop smoking.
- Avoid alcohol.
- Decrease stress or avoid stress as much as possible.
- Medications to treat heartburn.
Antacids: Many people take non-prescription antacids for mild or occasional heartburn.
- Antacids are medications that neutralize some of the stomach acid.
- Some antacids (such as Gaviscon) have a foaming agent (alginate) that floats on top of the stomach contents, which reduces acid contact with your stomach lining, and coats the esophagus.
- Liquid or dissolving antacids usually work faster than tablet forms.
- Antacids work faster than acid reducers (H2 blockers), but their effect does not last more than 1 to 2 hours. Examples of some non-prescription antacids include Mylanta, Maalox, Tums, or Rolaids.
- If you use antacids more than occasionally, talk with your health professional.
- Antacids do have side effects. They may cause diarrhea or constipation. Also, antacids can interfere with the absorption of other medications.
Regular use of antacids that contain magnesium or aluminum can cause a dangerous buildup of magnesium or aluminum in people who have kidney disease.
If you have any high-risk conditions and diseases, talk with your health professional before you start taking an antacid. If you have kidney disease, it is especially important to discuss antacid use with your health professional.
Stomach acid reducers (H2 blockers): Some heartburn medications that previously you could obtain only with a health professional's prescription are now available without a prescription. These are acid reducers (histamine receptor blockers, or H2 blockers).
- Acid reducers decrease the amount of acid that the stomach makes.
- Acid reducers generally provide relief for longer periods of time than antacids. However, antacids generally provide relief faster than acid reducers. Examples of some non-prescription acid reducers include famotidine (Pepcid AC), cimetidine (Tagamet HB), ranitidine (Zantac 75), or Axid AR.
- If you take a non-prescription acid reducer for longer than 2 weeks, talk with your health professional.
- Acid reducers can sometimes change the way other medications work. If you are taking prescription medications, be sure to talk with your health professional before taking a non-prescription acid reducer.
Your health professional may be able to prescribe other medications for your heartburn.
Symptoms to Watch for During Home Treatment
Use the "Check Your Symptoms" section to evaluate the symptoms if any of the following occur during home treatment.
- Your heartburn is not relieved by home treatment and medication.
- You continue to have blood in your vomit.
- You develop blood in your stools or black, tarry stools.
- You have symptoms of heartburn for more than 3 to 4 weeks.
- Your swallowing problems are not improving.
- You continue to have weight loss for no reason.
- Your symptoms become more severe or frequent.
HOLISTIC HOME TREATMENT FOR HEARTBURN
A NOTE ABOUT ANTACIDS
Antacids often provide relief of symptoms. However, in so doing, they may mask an underlying problem. In addition, many over the counter antacids contain excessive amounts of sodium, aluminum, calcium, and magnesium. With prolonged use of these products, dangerous mineral imbalances can occur. Excess sodium can aggravate hypertension, and excess aluminum has been implicated in Alzheimer's disease. Some of the most popular types of antacids and the products they are found in are:
- Aluminum salts or gels: AlternaGEL, Amphojel.
- Aluminum-magnesium mixtures: Aludrox, Di-Gel, Gaviscon, Gelusil, Maalox, Riopan.
- Calcium carbonate: Alka-Mints, Chooz, Titralac, Tums.
- Calcium-magnesium mixtures: Rolaids.
- Magnesium salts or gels: Phillips' Milk of Magnesia.
- Sodium Bicarbonate: Alka-Seltzer, Bromo-Seltzer, Citro-carbonate.
Calcium carbonate works as an antacid and contains no aluminum.
A product called Acid-Ease, from Prevail Corporation, has shown promising results. It can be purchased at health food stores and online. Acid-Ease provides digestive enzymes that help your system break down and absorb foods. Pure plant enzymes are combined with gamma oryzanol (found naturally in rice bran oil), slippery elm, and marshmallow root in a soothing supplement for even the most sensitive digestive systems. Take 2 capsules 3 times daily at the beginning of meals and may also be taken as needed between meals.
NUTRITION
Nutrition plays an important role in stopping the symptoms of heartburn. Be sure to include these recommendations in addition to the other lifestyle changes that are recommended above under Conventional Medical Treatment.
- At the first sign of heartburn, drink a large glass of water. This often helps.
- Try raw potato juice. Do not peel the potato, just wash it and put it in your juicer. See Juicing for more information. Mix the juice with an equal amount of water. Drink it immediately after preparation, three times a day.
- Change your eating habits. Eat more raw vegetables. Chew your food well. Eat slowly and enjoy your food. Follow a proper diet with plenty of lean protein to support your lean muscles and organs.
- Eat small, frequent meals throughout the day. Breaking your 3 large meals a day into 6 smaller meals (about half the size you would normally eat at a regular meal) will not only help with heartburn problems but will help curb hunger pangs and keep your blood sugar on a more even level. Avoid eating big meals. Again, take your time eating and chew your food thoroughly.
- Avoid very hot or very cold beverages. Avoid drinking large quantities of fluid with your meals. Instead sip them throughout the day between your meals.
- Sip 1 tablespoon of raw apple cider vinegar, mixed with a glass of water, while eating a meal. Do not drink any other liquids with meals.
- Eat fresh papaya and/or pineapple to aid digestion. Chew a few of the papaya seeds as well. Papaya Enzyme chewable tablets can be a substitute for fresh papaya.
- Do not eat for three hours before bedtime. Wait at least three hours after eating before lying down.
- Do not consume carbonated beverages, fats, fried foods, processed foods, sugar, or spicy or highly seasoned foods. These seem to be the main cause of heartburn.
- Do not take a multi-enzyme complex containing hydrochloric acid (HCl).
- Avoid a diet high in refined sugar. A diet high in sugar makes heartburn worse. It irritates the lining of the esophagus and stomach and increases stomach acid, fermentation of the sugar produces more stomach gas, and a high sugar content encourages the growth of certain stomach bacteria that recent medical studies say may cause chronic stomach ulcers. Eliminate or sharply curtail your intake of sugar, corn syrup, high-fructose corn syrup, molasses, and all food products made with them.
- Avoid alcohol. Alcohol should be avoided during pregnancy for other reasons besides heartburn. Alcohol, like sugar, has a directly hostile effect on the stomach lining and also stimulates increased stomach acid, but it has the added negative effect of weakening the muscular sphincter at the end of the esophagus, making reflux of stomach acid into the esophagus more likely. Eliminate or sharply curtail your intake of alcoholic beverages.
MoonDragon's Pregnancy Information: Alcohol & Pregnancy.
- Avoid chocolate, coffee and other caffeine containing products. Similarly, Chocolate produces an almost immediate weakening. The caffeine-like substance in chocolate seems to be the culprit in causing the problems. Substitute carob for chocolate, if possible. Coffee may also increase the output of stomach acid, try to reduce or eliminate drinking too much coffee.
- Eating a fatty meal causes a digestive response, allowing easy access for stomach acid into the esophagus. Try to limit the fat content of your foods to 30% of your total calories per day and to spread those fat calories out throughout the day as much as possible.
- Milk, although you might think of it as a food to soothe the "angry" stomach, actually has only a temporary neutralizing effect on stomach acid, followed later by a rise in stomach acid to an even higher level than it had been. A bite or two of cottage cheese, taken when you feel heartburn coming on, may help to ease it away. Try mixing a little honey in with your milk, which can also ease the burn and discomfort of heartburn.
Plain, unsweetened Yogurt is helpful. Yogurt is not only nutritious, providing calcium, but it also provides active "friendly bacteria" cultures, which helps to keep your intestinal tract healthy and functioning properly. The yogurt you choose should contain active cultures.
Milk is NOT a heartburn remedy! If you have problems with lactose intolerance (caused by an absence of an enzyme that breaks down lactose found in dairy products), drinking milk can aggravate your gastric system. You can take a "lact-aid" enzyme supplement to help with mild lactose intolerance.
Lactase Enzyme, Lactase Formula, EnzymeActive, Nature's Way, 230 mg, 100 Caps - Lactase Enzymes are a dietary supplement which supports the digestion of lactose rich foods. Lactase Enzymes are especially useful for those with lactose intolerance, but is also helpful for any lover of dairy products. Recommendation: For individuals with lactose intolerance or difficulty in digesting dairy products. Take three capsules as needed just prior to ingesting foods or beverages containing dairy products or lactose. Take one capsule if you are taking medications or vitamins containing lactose.
- Orange juice also causes problems in some people, because it is naturally acidic. Limit or eliminate citrus juices if they cause problems with your digestion.
- Avoid highly seasoned food. Spicy foods, especially those made with hot peppers or pepper, contain corrosive acids that directly irritate the stomach, contribute to heartburn. Try to avoid eating chili peppers, jalapenos, or other hot spices if they typically cause heartburn for you. Avoid black pepper. This is a natural irritant.
- Tomato products, such as juices, pastes, salsa and sauces (including marinara sauce and ketchup), may irritate the stomach and esophagus lining directly and may also cause heartburn for some people. If you like to grow your own tomatoes, there are some varieties that are naturally low in acid.
- See Fasting for instructions (fasting is not recommended during pregnancy). Also see the self-tests under Acidosis and Cardiovascular Disease.
HERBS
Always check with your health care provider or midwife before using herbal therapy or nutritional supplements during pregnancy. There are some herbs that should be avoided during pregnancy and lactation and other herbs and supplements should be used under supervision with proper dosages. The suggestions below are for "general population" heartburn and not necessarily "pregnancy specific."
- Aloe vera juice aids healing of the intestinal tract.
- Catnip, fennel, ginger, marshmallow root, and papaya tea all aid in the proper digestion and act as a buffer to stop heartburn.
- Gastritix Formula W/ Chamomile, Nature's Way, 474 mg, 100 Caps - Promotes a calming effect on the digestive tract. This formula contains chamomile, to promote normal tone in the digestive tract. Ginger Root, an aromatic bitter that stimulates digestion to promote gastrointestinal comfort. Fennel Seed, used traditionally to sweeten the breath and support digestion. Slippery Elm Bark and Marshmallow Root, traditionally used for their soothing and emollient effects on the digestive tract. Recommended dosage: Take 2 capsules with meals as needed.
- Enjoy a cup of Chamomile herbal tea. Chamomile's soothing qualities make it a wonderful treatment for heartburn and stomach upset by relieving esophageal irritation. Caution: Do not use chamomile if you have an allergy to ragweed. Do not use chamomile on an ongoing basis, as ragweed allergy may result. Do not use chamomile oil during pregnancy since the oil is a very potent uterine stimulant. It can be used safely in dried or fresh herb form as a tea.
- Calming Tea with Organic Chamomile for Daily Stress Relief, Yogi Tea, Caffeine Free, Certified Organic, 16 Tea Bags - Calming Tea by Yogi Tea is a safe and time-tested Ayurvedic formula designed to ease stress and tension, encouraging a state of relaxed alertness without drowsiness. This blend contains several herbs that are helpful for the relief of heartburn.
- Chamomile Tea, Caffeine Free, Yogi Tea, Certified Organic, 16 Tea Bags - This is pure, organic chamomile tea with no other added herbs. It is a well-known relaxant to relieve occasional sleeplessness, anxiety, as well as an antispasmodic for minor menstrual cramps and stomach discomfort.
- Licorice reduces the production of stomach acid which also decreases heartburn. Caution: Can have some negative side effects, such as constipation, headache, sodium and water retention, loss of potassium, and high blood pressure. Do not take licorice if you have high blood pressure. Moderate use of licorice may be used if you are pregnant and you don't have problems with high blood pressure. Consult with your midwife before using it as a heartburn remedy.
- To reduce gas, take cardamom or cinnamon. Use cinnamon in moderation during pregnancy. It is a uterine stimulant when used in high doses, but moderate culinary use is acceptable. Do not take it in essential oil form.
- Dill soothes the digestive tract. Crushed seeds are best. Use in a salad dressing or in other recipes for cooking. Caution: Use moderately if you are pregnant.
HERBS THAT MAY CAUSE HEARTBURN IN SOME PREGNANT WOMEN
- The use of chili may lead to heartburn when taken in high doses, but moderate culinary use is acceptable for use during pregnancy if it doesn't bother you. It may flavor breast milk in women who breast feed.
- Garlic may lead to heartburn when taken in high doses. It can flavor breast milk. Moderate culinary use is acceptable in pregnancy as long as it doesn't bother you.
- If peppermint you causes heartburn, avoid its use. Many people find it helpful for digestion and gastric problems. Peppermint is a uterine stimulant. Avoid oil completely during pregnancy. The dried herb is safe in cooking and can be used as a tea if you have problems with morning sickness or nausea.
NUTRIENTS Supplement Suggested Dosage Comments Very Important Aloe vera As directed on label. Aids healing of the intestinal tract. Aloe Vera Gel & Juice, 99.7% Pure, Certified Organic, Nature's Way, 1 Liter Pancreatin
Plus
BromelainAs directed on label. Take with meals. Enzymes necessary for proper digestion. Super Digestive Enzymes w/ Pancreatin, Bromelain & Other Digestive Enzymes, 90 Caps Papaya Tablets As directed on label. To relieve symptoms. Use chewable tablets form. Papaya Enzyme W/ Mint & Chlorophyll, Chewable, NOW Foods, 23 mg, 360 Lozenges Vitamin B complex
Plus Extra
Vitamin B-1250 mg 3 times daily, with meals
200 mcg 3 times daily.Needed for proper digestion.
Use a lozenge or sublingual form. Ultimate B Complex Formula, Nature's Secret, 60 Tabs, Ultra B-12, NOW Foods, 4 oz.Helpful Acid-Ease, from Prevail As directed on label. A soothing plant-enzyme and herb formula that aids in the breakdown and assimilation of foods. Digest Ease, Acid Neutralizer, Promotes Healthy Digestion, Banyan Botanicals, 90 Tabs Lactobacillus Acidophilus 1 to 3 capsules with each meal. A digestive aid that helps maintain intestinal flora. Primadophilus Optima, 35 Billion CFU, Nature's Way, 60 Vcaps Digestive Enzyme Combination 1 capsule with each meal. A digestive aid that helps promote better digestion. Avoid any complex that contains hydrochloric acid (HCl). Digestion Supplement w/ Enzymes, Nature's Way, 530 mg, 100 Caps MSM (Methylsulfonylmethane) Mix with your favorite juice or take alone. 1 to 2 teaspoons once or twice daily. MSM relieves hyperacidity without disturbing the normal acid-alkaline balance. MSM (Methylsulfonylmethane) Liquid, Pure Lignisul, 16 fl. oz.
Mountain Rose Bulk Herbs
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NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...
You have symptoms of heartburn that worsen or do not improve with treatment and lifestyle changes.
You have severe upper abdominal pain.
You have chest pain that is crushing or squeezing, feels like a heavy weight on the chest, or occurs with any other symptoms of a heart attack. Note: Symptoms of a heart attack and symptoms of heartburn may feel the same. It is important to consider all your other symptoms to determine if you have a more serious problem.
You have signs of shock. Shock is a life-threatening condition. Immediate medical care can make the difference between life and death. Early signs of shock (most of which will be present) include:
- Lightheadedness or a feeling that you are about to pass out.
- Restlessness, confusion, or signs of fear.
- Shallow, rapid breathing.
- Moist, cool skin or possibly profuse sweating.
- Weakness.
- Thirst, nausea, or vomiting.
Also, a person in shock usually has an abnormal increase in heart rate and an abnormal decrease in blood pressure.
Late signs of shock include:
- Changes in the person's level of consciousness, such as sudden unresponsiveness, faintness, loss of consciousness, or behavior changes.
- A pale face or blue lips or earlobes.
Shock may occur in response to a sudden illness or injury. When the body loses too much blood or fluids, the circulatory system cannot get enough blood to the vital organs, and shock results.
If the person has chest pain, after calling 911 or other emergency services:
- If the person becomes unconscious, see Rescue Breathing and Cardiopulmonary Resuscitation (CPR) in the topic Dealing With Emergencies.
- If emergency medical personnel (such as paramedics) are not going to arrive soon and the person is awake, alert, not vomiting, and not allergic to aspirin, have the person chew and swallow 1 adult aspirin (325 mg). Be sure to tell emergency personnel that aspirin has been taken.
- Life-threatening symptoms occur, including rapid, irregular heartbeat; chest pain; or loss of consciousness. Call for assistance immediately (usually 911)... THIS IS AN EMERGENCY!! Quick treatment to open the blocked artery is essential to lessen the amount of damage. At the first signs of a heart attack, call for emergency treatment. The best time to treat a heart attack is within one to two hours of the first onset of symptoms. Waiting longer than that increases the damage to your heart and reduces your chance of survival. Keep in mind that chest discomfort can be described in many ways. It can occur in the chest or the arms, back, or jaw. If you have symptoms, take notice. These are your heart disease warning signs. Seek medical care immediately.
- If any unexpected or unusual symptoms appear. Therapies, supplements, medications or other treatments may produce side effects in some individuals.
Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
-- by Phyllis A. Balch, James F. Balch
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