Female patients with pain in the middle of the chest should first undergo an electrocardiogram, unless it is caused by myocardial ischemia, which is more common in elderly patients. If necessary, nitroglycerin or isosorbide nitrate tablets can be given orally; a low-salt, low-fat diet and monitoring of blood pressure and heart rate changes should be observed. Some patients also suffer from esophageal diseases, commonly reflux esophagitis, which may be accompanied by significant acid reflux, belching, burning sensation behind the sternum, or significant abdominal distension. Patients can take oral omeprazole, which can also improve symptoms, or morbutine if necessary; and in severe cases, esophagogastroscopy can be performed. Usually oral medications are able to control the progression of the disease, and proton pump inhibitors can also be given intravenously.