X-ray diagnosis of cardiac spasms

This article was written by Specialist Doctor II Khong Tien Dat, Doctor of Radiology - Department of Diagnostic Imaging - Vinmec Ha Long International Hospital. The doctor has a lot of experience with more than 14 years working in the field of diagnostic imaging.

Cardiac spasm is a disease characterized by increased contraction of the lower esophageal sphincter when swallowing, preventing food from entering the stomach. The clinical symptoms of achalasia are diverse but non-specific. X-ray diagnosis of achalasia is a commonly used imaging tool.

Cardiac spasm is a disease belonging to the group of spasmodic disorders of the esophagus, specifically excessive spasm of the lower esophageal sphincter. The esophagus of people with esophageal spasm is often non-peristaltic and dilated, creating a bird's-beak image on esophageal radiographs.
Cardiac esophageal spasm is not a common clinical disease. Patients are usually a group of young people, concentrated between the ages of 30 and 50, and there is no difference between the sexes.
Cardiac esophageal spasm is not an acute, life-threatening condition, but it progresses silently and can lead to serious complications. People with spasmodic heart disease, if not detected and treated, may experience the following problems:
emaciation, exhaustion due to food not being able to enter the stomach for digestion and absorption Recurrence esophagitis times Esophageal stricture Esophageal cancer Complications in the respiratory tract caused by reflux of food such as recurrent pneumonia, airway obstruction, lung abscess.

Cardiac spasm is characterized by a long, silent progression. The disease is not a life-threatening emergency and requires immediate treatment, but it is a nuisance and impairs the patient's quality of life. The early stages of the disease usually show no suggestive signs. Symptoms of spasmodic heart disease often appear clinically after a while, can be:
Swallowing: patients most often complain of symptoms of choking with both liquid and solid foods. Swallowing in achalasia does not occur sequentially from solid foods to liquid foods as with esophageal cancer, but occurs simultaneously, randomly with both liquid and solid foods. Symptoms of dysphagia also do not appear continuously throughout the patient's life. Chest pain: Dull chest pain behind the sternum corresponding to the path of the esophagus in the chest. Chest pain increases after swallowing, due to food stagnation in the esophagus for a long time Gastroesophageal reflux, belching, heartburn, bad breath due to old food remaining in the esophagus Weight loss, depression: When achalasia develops for a long time but is not detected and treated, the patient easily becomes emaciated and exhausted because food cannot enter the stomach to be digested and absorbed. Respiratory manifestations: when food refluxes into the respiratory tract, the patient may have extra-gastrointestinal manifestations such as cough, difficulty breathing, increased chest pain, high fever in the context of pneumonia or abscess. lung. Symptoms of gastroesophageal spasm are diverse but not specific. Many other conditions can also cause similar symptoms. Therefore, the diagnosis of cardiac spasm is mainly based on laboratory tests.

Diagnosis of achalasia needs to be done accurately and quickly to improve the patient's quality of life. The clinical symptoms of achalasia are often more suggestive of an abnormality of the upper gastrointestinal tract than diagnostic because of their low sensitivity. There are many laboratory tools that are helpful in the diagnosis of achalasia, of which esophageal radiography is the most commonly used. Diagnostic radiographs of achalasia are performed with the use of contrast agents. In typical cases, cardiac spasm manifests on X-ray with the following images:
Large dilated esophagus, lower esophageal sphincter constricts, creating a bird's-beak image at the end of the esophagus. Esophageal spasmodic movement is rarely seen The inner wall of the esophagus is usually smooth, an ulcer can be seen if complications of esophagitis are present. Gastric balloons are not observed In addition, the diagnosis of achalasia is also is reinforced by the following means:
Measurement of intra-esophageal pressure by manometer: this is the most accurate way to diagnose esophageal spasm. The failure of the lower esophageal sphincter to relax when the patient swallows is the surest sign. Elevated intraesophageal pressure at rest and no peristalsis in the lower esophagus are also diagnostic features. Gastroduodenal endoscopy: this is a tool that plays a role in differential diagnosis with other diseases of the esophagus that cause similar symptoms such as difficulty swallowing, painful swallowing. Esophageal cancer and reflux esophagitis are conditions that should be prioritized for exclusion. Other imaging modalities such as ultrasound, computed tomography or magnetic resonance imaging do not play much of a role in the diagnosis and monitoring of gastroesophageal spasm.

When esophageal spasm is suspected, the doctor will order an X-ray of the esophagus to diagnose the disease. This is an imaging tool that uses X-rays to examine the esophagus and detect abnormalities within the lumen or surrounding areas.
Patients before performing esophageal X-ray to diagnose gastroesophageal spasm should note the following: Abstain from eating and drinking completely before the procedure at least 6 hours. The patient can drink a little water 2 hours before the x-ray. Tell your healthcare provider about any allergies you have, especially to contrast dyes. Do not bring jewelry into the examination room. Immediately notify the treating doctor if the patient has unusual symptoms that suggest esophageal perforation, intestinal perforation, intestinal obstruction, severe constipation.