At the beginning of a running warm-up, a patient reports the onset of heartburn and difficulty swallowing. The MOST likely cause of these symptoms is which condition?

• A. Myocardial ischemia
• B. GERD
• C. Peptic ulcer disease
• D. Cholelithiasis

Answer: (B)

Heartburn with difficulty swallowing during or after activity points to an esophageal cause rather than a cardiac one. The most likely explanation is GERD, where stomach acid refluxes into the esophagus because the lower esophageal sphincter isn’t controlling the passage of contents effectively. That reflux irritates the esophagus, causing the burning chest sensation (heartburn) and can lead to dysphagia, or a feeling that food is sticking when you try to swallow.

Exercise can worsen reflux due to increased abdominal pressure and transient relaxation of the lower esophageal sphincter, which makes symptoms more noticeable during a warm-up.

In contrast, myocardial ischemia would usually present with chest pressure or squeezing, possibly radiating to the arm or jaw, with shortness of breath or sweating rather than primary heartburn and swallowing trouble. Peptic ulcer disease tends to cause gnawing epigastric pain that isn’t typically associated with dysphagia. Cholelithiasis causes right upper quadrant or epigastric pain after meals, not heartburn or swallowing difficulties.

So, the combination of heartburn and dysphagia during activity best fits GERD.