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

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 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 AdventHealth.

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.

Heartburn sensation is different from having chest pain. 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 sometimes be a sign of heart disease.

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.

What is a Heart Attack?

A heart attack — medically known as a myocardial infarction — occurs when blood flow to the heart is stopped. This makes it very hard for heart muscle to receive the oxygen it needs to survive.

Heart attacks happen when an artery carrying blood to the heart becomes blocked by cholesterol, fat, and other substances that build up and form "plaques" on the inside walls of the artery. The formation of these arterial plaques is medically known as atherosclerosis.

Main Symptoms of a Heart Attack Include:

• chest pain, tightness or discomfort
• pain that spreads to parts of the upper body, including arms, neck, jaw and teeth, as well as sometimes the back and stomach
• shortness of breath
• sudden dizziness
• nausea
• cold sweat
• fatigue

According to the U.S. Centers for Disease Control and Prevention, someone in the U.S. has a heart attack every 40 seconds. According to the American Heart Association, the average age for a first heart attack is 65.6 years for men and 72 years for women.

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), and 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. If symptoms resolve spontaneously, visit your primary physician or cardiologist ASAP.

What is Heartburn?

Heartburn is a symptom of indigestion in the stomach that causes acid reflux -- rising of stomach acid into the esophagus, which is the tube that connects the stomach and throat.

Because one of the main symptoms of heartburn is a burning pain in the chest, it is often mistaken for a heart attack. A bitter taste in the mouth may also accompany the burning sensation.

Despite its name and the fact that it causes chest pain, heartburn has nothing to do with the heart.

According to the National Library of Medicine, over 60 million people in the U.S. have heartburn at least once a month.

While occasional heartburn is not considered serious, more frequent bouts may be caused by a condition called gastroesophageal reflux disease (GERD) known to cause acid reflux repeatedly. Pregnancy, obesity and certain medications can also raise a person's risk for heartburn.

Signs that are more likely to signal heartburn:

If the pain consistently happens while resting, after eating spicy or greasy food or when lying down shortly after eating and is accompanied by burping, belching, abdominal bloating, and an acid/bitter taste in the mouth, odds favor heartburn, Dr. Lozano says. If the pain is triggered by exertion, physical or 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. You may need to be evaluated with a CT scan of the coronary arteries or heart catheterization to evaluate the status of your coronary arteries and rule out blockages that could lead to heart attack and chest pain.

What types of conditions can lead to chest pain?

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

Only your doctor can differentiate among these conditions after a physical examination and running blood tests, EKG, US and sometimes more invasive tests like heart catheterization and EGD.

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.

What digestive conditions signal chest pain?

When it comes to acid reflux, chest pain can be triggered 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 disorders such as acid reflux and esophageal spasm or gallbladder disease, he says.

Heart attack 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 signs 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 and chest discomfort/pressure/tightness.

How Can I Tell If I’m Having a Heart Attack, Heartburn or Angina?

It can sometimes be hard to tell if what you're experiencing is heartburn vs a heart attack because they both cause pain in the chest and can have similar symptoms.

However, there are a few ways you can tell the difference between heartburn vs heart attack:

While heartburn causes a burning pain in the chest, heart attack causes more of a feeling of tightening or pressure than pain.

Heart attacks usually include pain that travels to other parts of the body while a heartburn does not. Symptoms of a heart attack like cold sweat, dizziness or shortness of breath do not normally occur with heartburn. Heartburn generally worsens after eating, when lying down or bending over. Bloating and belching are not common symptoms of heart attacks. Heartburn symptoms will generally improve quickly when taking an antacid.

If there’s any double what you’re experiencing may be a heart attack or angina, call 911 or have someone drive you to the nearest emergency room. It is important to take the warning signs of a heart attack seriously.

How Can I Prevent Heart Burn?

Heartburn is mainly treated through antacid medications available over-the-counter. Other medications may be used if heartburn is more frequent.

Most heartburn can be prevented by making some lifestyle changes, including:

• avoiding spicy and acidic foods
• consuming smaller meals
• eating a healthy diet
• eliminating stress
• exercising
• losing weight
• lowering caffeine consumption
• sitting upright after eating
• quitting smoking

When Should I See a Doctor for Heartburn and Heart Attack Symptoms?

A heart attack is a major medical emergency and because it shares a lot of similar symptoms to heartburn, we urge our patients to err on the side of caution and seek immediate medical attention if they have any doubts.

If you know what you're experiencing is heartburn vs heart attack, taking antacids and making some lifestyle changes can easily relieve occasional heartburn.

However, if your heartburn symptoms persist or you start having it more frequently, it may be time to visit your doctor. Uncontrolled heartburn can cause damage to your esophagus and teeth and may increase your risk for esophagus cancer. Persistent heartburn can also be a sign of a more serious condition called gastroesophageal reflux disease (GERD).

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!