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Am I Having Heartburn Or A Heart Attack?
Heart attacks and heartburn both cause chest pain. If you or someone near you is experiencing chest pain — especially if it comes on suddenly and is accompanied by nausea or pain in your shoulders — call 911 as soon as possible.
Heart attack and heartburn are two different conditions that can have a similar symptom: chest pain. And while some movie depictions of heart attacks make them seem like big, chest-clutching displays, that's not always the case.
This article explores some ways to tell the difference between heartburn and heart attack. However, if you're ever unsure about what you may be experiencing, it's always better to be safe than sorry.
If your chest pain is making you nervous, head to the nearest emergency room.
To understand how these two conditions can cause chest pain, consider the causes behind the two.
Heart attackA heart attack (also called a myocardial infarction) is when a major artery or arteries in your heart don't get enough blood flow. As a result, areas of your heart don't get enough blood and oxygen. Doctors call this state ischemia.
To understand ischemia, think about going from standing still to running a full-out sprint.
At the end of a few seconds, your lungs are likely burning and your chest feels tight (unless you're a star athlete). These are some examples of very temporary ischemia that gets better when you slow your pace or your heart rate catches up.
However, when a person has a heart attack, their heart can't work to produce more blood flow. The results can be chest pain, but other symptoms occur too.
Different arteries in the heart supply blood to different areas of the heart. Sometimes, a person's symptoms can vary because of where they're experiencing their heart attack.
Other times, the symptoms are different because people's bodies respond differently to lack of blood flow and oxygen.
HeartburnHeartburn occurs when acid that's usually in your stomach rises up into your esophagus (the tube between your mouth and stomach) and sometimes into your mouth.
The acid in your stomach is meant to dissolve foods and nutrients. Your stomach lining is strong enough so it's not affected by the acid.
However, the lining of the esophagus doesn't have the same kind of tissues as the stomach. When the acid comes up into the esophagus, it can create a burning sensation. This can cause chest pain and discomfort.
While heartburn and heart attack both have chest pain as a symptom, the areas in and around the chest that are affected by pain, and the pain sensations themselves, are slightly different.
Heartburn typically includes a burning sensation that starts in the upper part of the stomach and radiates to the chest.
A heart attack typically includes an uncomfortable sensation in the center or left side of the chest that's sometimes described as pressure, squeezing, or a "fullness."
Both heart attack and heartburn have additional symptoms, which may include:
Again, if you're feeling a very uncomfortable sensation in your chest and can't be sure whether it's heartburn or a heart attack, it's always better to err on the side of caution and see a doctor ASAP.
Women and heart attacksDo women experience heart attack symptoms differently than men?
According to the University of Utah, while the symptoms of a heart attack are technically the same in men and women, it's possible that women may experience pain differently than men.
This differentiating pain threshold level may cause women to either underreport symptoms or simply ignore them.
This pain threshold difference is not scientifically proven, however, and there are other studies that find women are more sensitive to pain.
Another reason women may have a different reaction to symptoms of a heart attack is that this health issue is sometimes portrayed as a "man's issue" in popular culture.
But according to the Centers for Disease Control and Prevention (CDC), every year in the United States, heart disease (which includes heart attacks) kills just as many women as it does men.
So it bears repeating: If you're feeling tightness or pain in your chest, and you can't think of a direct cause, call 911 or local emergency services, or get to a doctor as soon as you can.
The questions below are designed to help you if you're ever in a situation where you're trying to decide whether you or someone else is experiencing a heart attack or just heartburn.
1. What makes your symptoms better?With heartburn, sitting up and taking antacids usually helps the pain. Lying flat and bending forward makes it worse.
With a heart attack, antacids and sitting up likely won't improve your symptoms. Activity will usually make them worse.
2. When did you last eat?With heartburn, you're most likely to have symptoms within a couple of hours after eating. If you haven't eaten anything in a while, it's less likely your symptoms are reflux-related.
With a heart attack, your symptoms aren't eating-related.
3. Does the pain radiate?With heartburn, your pain may go up to your throat.
With a heart attack, the pain may go up to the jaw, back, or down one or both arms.
4. Are you short of breath or sweating?With heartburn, your symptoms should not usually be this severe.
With a heart attack, these symptoms can indicate ischemia and a need to seek emergency medical attention.
Heart attack and heartburn aren't the only causes of chest pain, but they're two of the most likely ones. Other potential symptoms include:
If you're having chest pain that you think could be a heart attack, don't drive yourself to the emergency room. Always call 911 or local emergency services so you can get medical attention as quickly as possible.
The more time the heart goes without proper blood flow, the more damage the heart muscle may undergo. This is why it's not a good idea to wait or hesitate if you think you may be experiencing a heart attack.
While a key symptom of both heart attack and heartburn is chest pain, there are other symptoms that can help differentiate between the two issues.
However, it's always better to be cautious than to simply default to "I'm fine, it's probably nothing."
If you're ever in a situation where you're experiencing chest pain — especially if it comes on suddenly and is accompanied by pain in your shoulders or nausea — call 911 as soon as you can.
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Symptoms Of Acid Reflux
Acid reflux occurs when stomach contents travel up the esophagus to your throat. Symptoms include pain or burning in your chest, a sour or bitter taste in your mouth, a hoarse voice, or chronic cough.
When you eat, food travels from the mouth down the esophagus. The esophagus is a tube that connects the mouth with the stomach and is typically 10 inches in length.
There is an opening between the esophagus and the stomach that enables food to travel into the stomach. After food passes through, the opening closes.
But if the opening doesn't close, contents in the stomach can travel back through the opening into the esophagus. This can be irritating and cause many symptoms.
People may also refer to acid reflux as:
Most people will experience acid reflux occasionally. Sometimes, they won't even feel it when it happens. In some cases, acid reflux can be mild and may happen after eating larger meals.
In other cases, acid reflux can occur more frequently. If acid reflux occurs two or more times a week for a few consecutive weeks, this could be due to gastroesophageal reflux disease (GERD).
GERD is a chronic condition that features acid reflux as a symptom. It occurs in up to 20% of the U.S. Population.
GERD and acid reflux are not the same thing. GERD is a disease involving chronic symptoms of acid reflux.
Some people with acid reflux may experience no symptoms and not realize they are experiencing acid reflux. Other people may experience symptoms that could range from mild to severe.
Both acid reflux and GERD, the chronic form of acid reflux, can cause common symptoms like heartburn and regurgitation.
HeartburnHeartburn can be a pain or burning feeling in the chest.
It may appear in the:
This burning sensation may move and rise from the lower part of the breastbone up into the throat. This happens when stomach acid that travels back from the stomach into the throat touches the esophagus lining.
Stomach acid may travel back up into the throat after consuming a large meal or when lying down. In some people, like those with GERD, this can happen frequently.
The feeling of heartburn can last from a few minutes to a few hours.
The severity of heartburn can vary between people and may range from mild to severe. The types of foods and amount of food people eat can be factors that influence the severity of heartburn.
RegurgitationAcid reflux will commonly cause regurgitation. This involves contents of the stomach travelling back into the throat.
This may cause an unusual taste in the mouth. This taste may be:
The reason the taste may be sour or bitter is due to the presence of stomach acid in the mouth due to regurgitation.
In infants, regurgitation is typical and people may also refer to it as "spitting up."
Sometimes, people may mistake regurgitated stomach contents from infants for vomit. But this is not the same thing. Other symptoms also accompany vomiting, like gagging or retching.
In infants, regurgitation can occur due to the size of the esophagus. The volume of this tube is small. Infants may also have large liquid meals and spend lots of time lying down. Both of these factors may also contribute to regurgitation.
Not everyone with acid reflux will experience heartburn or regurgitation. Some people may experience no symptoms at all, while other people may experience other symptoms.
Other possible symptoms that may occur due to acid reflux include:
Adults with GERD, the chronic form of acid reflux, may also experience additional symptoms including:
Infants with GERD may also experience additional symptoms, including:
In some cases, symptoms of acid reflux could be an indication of something more serious. It is important to contact a healthcare professional to rule out other potential conditions.
Acid reflux can cause chest pain, and it can be difficult to distinguish if this is due to acid reflux or something serious like a heart attack.
If in doubt, it is important to have a healthcare professional immediately assess chest pain. Erring on the side of caution to check if pain is due to a heart attack, angina, or another condition is a good idea.
Numerous conditions can cause symptoms that may appear similar to GERD in infants.
Consult a healthcare professional right away if your infant:
Contact a healthcare professional if you are an adult with acid reflux experiencing symptoms that may indicate a complication of GERD or another condition. These symptoms include:
Not everyone with acid reflux will experience symptoms, and some people may have it without realising. Other people may experience symptoms that range from mild to severe.
Common symptoms of acid reflux include heartburn and regurgitation. Other possible symptoms include chest pain, nausea and difficulty swallowing.
Some symptoms of acid reflux, like chest pain, could also be due to a medical emergency like a heart attack. If in doubt, speak with a medical professional.
Signs Of Heart Attack That Resemble Gastric Trouble; Experts On How To Differentiate Between The Two
Heart burn or stomach ache could be a sign of heart attack and ignoring these symptoms may lead to dangerous consequences, as per experts. It is not uncommon for symptoms of gastric trouble and heart attack to overlap. A person having heart attack may experience heart burn, chest pain, stomach ache, nausea but may confuse these symptoms for gastric issues. In the state of confusion, the patient instead of rushing to the hospital, may take antacid which could even provide temporary relief, but delay the real treatment. This could prove to be deadly for the one having heart attack with the abovementioned symptoms. (Also read: 8 heart attack signs and symptoms people should not ignore)
It is important to know that in case of heart attack, the chest pain can feel like pressure, or squeezing in the chest lasting more than a few minute and it may come and go. The pain in case of heart attack may spread to shoulders, back, neck, teeth or jaw. Apart from these issues, one may also experience shortness of breath, panic attack, lightheadedness that are classic symptoms of heart attack.
Dr. Mukharjee Madivada, Senior Interventional Cardiologist, Managing Director, Pulse Heart Center. Director, Pulse Heart Charitable Trust, Founder - Ex President, IMA Kukatpally recently shared a case study on his Twitter handle where one of his patients - a diabetic and a smoker - took antacid for chest burning, while he was actually having a heart attack. After the burning partially subsided, the patient thought it was gastritis and delayed going to the hospital till the next day.
"Mr. KR had chest burning two days ago. He has diabetes and he smokes an occasional cigarette. His immediate fear was that he was having a heart attack. But he strongly believed that with his good genes he wouldn't have a heart attack at 45 years. He wanted to go to the doctor, but before that he wanted to make sure that the pain was not due to gastritis. He drank an antacid syrup and a few minutes later the burning subsided partially. Relieved, he took rest from the office that day. He went to his family doctor the next day evening as he still had mild burning. His doctor took an ECG which showed a heart attack and he referred Mr. KR to me. I did an angiogram, fixed his block and he is stable now. But because he delayed the treatment for his heart attack for a day, his heart would never be the same: it will be weak. Reduction of chest pain partially or completely with antacids, is not a definitive evidence that the pain is due to "gas". It could still be heart-related. Most heart attacks mistaken for gastritis start with chest pain that partially responds favourably with antacids. This totally deludes the patient who is already in denial about having a heart disease. This advice is more pertinent for people with strong risk factors for heart attack like diabetes, smoking habit, etc …Mr. KR at least could reach the hospital. Some may not be so fortunate," wrote Dr Madivada on his Twitter handle.
"Adults with chest pain account for a large number of emergency department (ED) visits. Patients present with a spectrum of signs and symptoms reflecting the many potential etiologies. Diseases of the heart, aorta, lungs, esophagus, stomach, mediastinum, pleura, and abdominal viscera may all cause chest discomfort. Gas pain in the chest is usually described as a sharp or dull discomfort that may be accompanied by burping or flatulence. The pain is typically located in the upper abdomen or upper chest, and may radiate to the back or shoulder. Heart pain, on the other hand, is typically described as a squeezing or pressure sensation that may radiate to the jaw, neck, or arm. It is important to note that heart pain can be felt in the upper abdomen or upper chest, so it's essential to distinguish between the two by considering other symptoms and risk factors," says Dr. Vivudh Pratap Singh
Senior Consultant, Interventional Cardiology, Fortis Escorts Heart Institute, Okhla Road, New Delhi.
"It's common to see people misdiagnose a heart attack as gastric trouble and delay reaching hospital. In heart attack, time is very important. Each passing minute, heart muscles get impacted. It's very important to understand difference between gastric trouble symptoms and heart attack symptoms. Many a time, it's difficult even for doctors to differentiate. Commonly a gas trouble is suspected when someone has burning in or pain in abdomen epigastrium or naval area. This discomfort gets aggravated by or related to eating unhealthy, spicy or masala food or due to empty stomach. The discomfort may radiate to back. Heart attack also can have Retrosternal burning or pain. It's more diffused in nature but generally it's not related with food intake and sometimes it may radiate to left or right arm or jaw area, associated with sweating and gets aggravated by activity and improves with taking rest," says Dr Bharat Vijay Purohit, Sr. Consultant Interventional Cardiologist & Director of Cath Lab, Yashoda hospitals Hyderabad.
What to do in case of confusion
"Generally heart related discomfort does not happen below the naval area. If in doubt regarding heart or gastric trouble it's better to do ECG or Troponin, Echocardiogram and last but not least an Angiography to clarify. Most important is trust your doctor and co-operate in investigation to ascertain cause of discomfort. An overdiagnosis and some extra tests are better then underdiagnosis and missing a heart attack and passing it off as gastric trouble," says Dr Purohit.
"20-40% of people visit a GP at least once in their lifetime with the complaint of chest pain.
While any chest pain should raise the suspicion of a heart related pain called angina about 15% have chest pain because of dyspepsia due to gastritis gastric reflux or indigestion. It's often a challenge for practitioners to differentiate between the two. In most cases if the chest pain gets worse on exertion, if it's located centrally behind the breast bone, if it's squeezing or pressing associated with sweating, it indicates a heart related pain. If it's associated with burping due to heavy meal and unrelated to exertion, and is if burning type it may indicate heartburn due to hyper-acidity. Having said that there is considerable overlap and often both problems can co-exist. So what is important is to have a high index of suspicion for ruling out heart attack. Heart related pain is a serious condition and needs to be recognised and treated promptly. Often it may be a precursor for a heart attack and if ignored may be life threatening," says Dr. V. Rajasekhar, Senior Consultant Interventional Cardiologist & Electrophysiologist, Certified Specialist for TAVR (Percutaneous Trans Aortic Valve Replacement), Yashoda Hospitals Hyderabad.
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