Blog · Digestion & anxiety
When your chest pounds, your stomach burns and A&E finds nothing wrong
How a tense gut can set off palpitations, reflux and panic, and what I do to settle it.
By Ela Pękalska ·
Many women arrive telling me the same story. Their heart started racing, there was a pressure in the chest and a burning behind the breastbone, and they were sure it was a heart attack. They went to A&E. The ECG was normal, the blood tests were normal, and they were told it was probably anxiety and sent home.
That is a relief, and it is also a puzzle. Why would anxiety make the chest hurt, the heart skip and the stomach burn all at once? In my clinic the answer usually starts in the digestion.
First, a safety note
Chest pain, a racing heart or breathlessness should always be checked. Call 112 for chest pain that is crushing or spreads to the arm, jaw or back, or if you are short of breath, sweating or feel faint. Going to A&E was the right thing to do. This post is about what can be going on once your heart has been checked.
What Chinese medicine sees: the Liver pressing on the Spleen
In Chinese medicine the Liver keeps Qi moving smoothly through the body. Pressure, frustration, worry and swallowed emotion make that movement tight and stuck. When Liver Qi stagnates, it presses against the digestive organs. This pattern is called the Liver attacking the Spleen and Stomach. The Spleen in Chinese medicine covers most of digestion, including the work Western medicine gives to the pancreas.
Stomach Qi is meant to travel downward. Under this pressure it rebels upward instead, which shows up as reflux, belching, hiccups, a sour taste and nausea. Add bloating, tightness under the ribs and an appetite that comes and goes, and you have a digestion that is tense and out of rhythm.
What I find under my hands
Good digestion depends on valves that open and close at the right moment. Under stress they tighten or lose their timing.
- The sphincter of Oddi is a small muscular valve where bile from the liver and gallbladder, and digestive enzymes from the pancreas, enter the intestine. When it goes into spasm, the area under the right ribs and the upper abdomen becomes tight and tender, and the discomfort can reach the back or the right shoulder blade.
- The valve between the oesophagus and the stomach should stay shut except when you swallow. When it becomes dysfunctional, acid and gas travel upward, and you feel burning behind the breastbone.
- The diaphragm sits right beside both. A stressed body braces it, and the oesophagus passes through a small opening in it. With the stomach pulled and pressured, the top of the stomach can slide up through that opening. This is a small sliding hiatal hernia. It is common, often minor, and it makes reflux worse.
This is how I understand it after years of working with these women. It is a clinical model that fits what I feel under my hands and what my clients report, rather than a proven chain of cause and effect.
Why it feels like your heart
The oesophagus runs directly behind the heart. Acid, spasm and trapped gas there cause pain in the centre of the chest that can be impossible to tell apart from heart pain without tests. Reflux is one of the most common causes of chest pain once the heart has been cleared.
Palpitations come through the vagus nerve, which links the brainstem to both the heart and the digestive tract. A full, gassy, irritated stomach pressing up against the diaphragm sends irritated signals along that nerve, and skipped beats or a pounding heart can follow. This link has a name in the medical literature: gastrocardiac, or Roemheld, syndrome.
Most of the vagus nerve’s fibres carry information up from the body to the brain. When the gut keeps sending up irritation, the brain reads it as danger. Anxiety rises, breathing turns shallow and quick, you swallow more air, the muscles tighten, and the gut gets worse. The gut feeds the anxiety and the anxiety feeds the gut.
What I do
I begin by listening to the whole story: when it happens, what you eat, how you sleep and what is weighing on you. I look at your tongue, take your pulse, and feel the abdomen, ribs and diaphragm to find where the tension is held. Treatment follows in the same session.
- Visceral therapy: slow, gentle hands-on work around the stomach, liver, gallbladder and upper abdomen, to ease tension and restore movement to the tissues around those valves.
- Myofascial release of the diaphragm, ribcage, upper back, neck and throat, to give the vagus nerve more room. It travels down the neck and passes through the diaphragm alongside the oesophagus.
- Acupuncture to settle the Liver and Stomach pattern, calm the nervous system and relax the muscular spasm.
When the tension releases, the vagus nerve has space to do its job. It calms down, digestion improves, and the anxiety eases with it. During a session many women notice a long exhale, a gurgling stomach, warmth in the belly and a softer chest. Most need a course of sessions rather than one, and I pace them to what your system can take in.
Small things that help between sessions
- Eat sitting down and slowly, in smaller portions, and not while stressed or on the move.
- Leave a few hours between your last meal and lying down.
- Breathe out slowly for a few minutes, making the exhale longer than the inhale.
- Do not stop or change any medicine, including acid-reducing tablets, without talking to your GP.
When to see your GP
See your GP promptly if you have difficulty swallowing, food sticking, unexplained weight loss, repeated vomiting, black stools, or reflux that does not settle. These need a proper medical check.
If this sounds like you
You can read more about acupuncture for anxiety, panic and overwhelm, IBS and digestive health, and the bodywork I use, including visceral therapy. If you would like to talk it through, get in touch.