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When in Doubt, Check it Out: Heartburn vs. Heart Attack

POSTED BY: Florida Hospital

Let’s say you’re at the dinner table. You’ve just chowed down on a massive plate of spaghetti and you feel a burning sensation in your chest. The telltale signs of heartburn, right? You take an antacid and hope it goes away. Consider this, though: There’s a chance the pain in your chest is actually the sign of a heart angina or even a heart attack. 

In other words, ignoring chest pain can sometimes be fatal. “It may represent the first sign of several life-threatening conditions such as a heart attack, a tear in the aorta (the largest blood vessel in the body) or a blood clot in the lungs,” says Hector Lozano, MD, cardiologist at Florida Hospital. 

When it comes to heartburn and heart attacks, it is tricky. “Both can be in the middle of the chest or left side of the chest, both can radiate to the left arm and left shoulder,” explains Ahmad Idris, MD, gastroenterologist and internal medicine specialist, also at Florida Hospital.

“Heartburn sensation is different than having chest pain,” Dr. Idris adds. “Heartburn by itself is indicative of acid reflux disease. On the other hand, chest pain can be related to either reflux disease or heart disease. Chest pain with indigestion sensation in some patients especially diabetics can be a sign of heart disease sometimes.”

If you suffer from heartburn regularly, you probably know the symptoms. But if you rarely have heartburn and suddenly feel pain, you need to get help.

Signs that are more likely to signal a heart attack

“Alarm signals that should prompt you to seek immediate attention include: prolonged duration (more than 15 min continuously), associated symptoms such as shortness of breath, palpitations, nausea, vomiting, clamminess/sweating, lightheadedness or fainting,” explains Dr. Lozano. “When in doubt, the best thing to do is to err on the side of safety and go to the emergency room or if symptoms resolve spontaneously visit your primary physician or cardiologist ASAP.”

Signs that are more likely to signal heartburn

 “If the pain consistently happens while resting, after eating spicy or greasy food or when laying down shortly after eating and is accompanied by burping, belching, abdominal bloating and an acid/bitter taste in the mouth odds are in favor of heartburn,” Dr. Lozano says. If the pain is triggered by exertion, physical/emotional stress and is accompanied by shortness of breath, palpitations, nausea, vomiting, clamminess/sweating, lightheadedness or fainting it’s probably cardiac.”

“Your doctor or the ER doctor will run an EKG and blood tests called Troponin to rule out a heart attack,” Dr. Idris says. “You may need to be evaluated with CT scan of the coronary arteries or heart catheterization to evaluate the status of your coronary arteries and rule out blockage that could lead to heart attack and chest pain.”

What types of conditions can lead to chest pain?

Dr. Idris says the list includes heart attack and angina, clot in the lung, dissecting aneurysm, acid reflux, esophageal spasm, pleurisy, musculoskeletal pain, gallstones and pancreatitis.  

“Only your doctor can differentiate among all these conditions after physical examination and running blood tests, EKG, US and sometimes more invasive tests like hearth catheterization and EGD,” he says.

“Multiple organs like the heart and the esophagus/stomach are enervated with the vagus nerves, which transmit the pain signals to the brain from the affected sick organs. That explains why it is hard to pinpoint the origin of the pain by depending on symptoms alone,” he says.

What digestive conditions signal chest pain?

When it comes to acid reflux, chest pain can be trigged by eating fatty food, spicy food or carbonated beverages, but still you always have to rule out the heart as a cause of chest pain by seeking medical help. “After ruling out a heart attack and angina, your doctor might treat you for acid reflux or send you to see a gastroenterology (GI) specialist to rule out esophageal disorder such as acid reflux, esophageal spasm or gallbladder disease,” he says.

Symptoms you may not expect

There can also be some unusual symptoms that you might not expect. “Certain populations such as women, diabetics and the elderly tend to present with atypical or unusual symptoms of heart attack or with no symptoms at all ("silent heart attack”),” Dr. Lozano says. “Some of the most common unusual symptoms include jaw pain, neck pain toothache, shoulder-blade pain, arm or shoulder pain, shortness of breath, fainting, chest discomfort/pressure/tightness.”

When in doubt
If you’re unsure if your chest pain is caused by indigestion or a heart attack, have it checked out. Always err on the side of caution!