Question: My father frequently experiences heartburn, but sometimes I worry that what feels like heartburn to him could be a heart attack. How can you tell the difference, and when should someone seek emergency care?
Answer: Many people worry that heartburnlike symptoms could be a heart attack — and that concern is understandable. Heartburn and chest discomfort caused by a heart problem can sometimes feel remarkably similar. Although there are important differences between the two, the symptoms can overlap enough that it isn’t always possible to tell the difference without a medical evaluation.
One reason the distinction is difficult is that internal organs don’t signal pain the same way muscles, bones and joints do. If you stub your toe, your brain quickly recognizes where the pain is coming from. But the heart, esophagus, lungs and even the muscles and joints of the chest can all cause discomfort in a similar area. Because those sensations overlap, it can be hard to know where the pain is coming from. Even healthcare professionals often need to get additional information from a good physical examination, an electrocardiogram (ECG or EKG), blood work and other testing to determine the source of the symptoms.
Heartburn is most commonly caused by acid reflux, which occurs when stomach acid flows back into the esophagus. It typically causes a burning sensation behind the breastbone and may leave a sour or acidic taste in the mouth. Symptoms often develop after eating and may become worse when lying down or bending over. Certain foods and beverages, large meals, excess weight, tobacco use, and lying down soon after eating all can increase the likelihood of heartburn.
Heart-related chest discomfort has some characteristic features, although symptoms can vary from person to person. Many people describe pressure, heaviness, squeezing or tightness in the center of the chest rather than a burning sensation. A common misconception is that every heart attack causes sudden, severe chest pain. While some people experience symptoms that way, others notice milder pressure or fullness instead. The discomfort also may spread to the shoulders, one or both arms, neck, jaw, back or upper abdomen. And it may occur with shortness of breath, nausea, lightheadedness or dizziness.
Some symptoms make a heart problem less likely. Chest pain that’s very sharp, lasts only a few seconds, changes when you take a deep breath or moves from one location to another is generally less suggestive of a heart problem. However, that doesn’t necessarily mean it’s harmless. Conditions affecting the lungs, major blood vessels or digestive system also can cause chest pain and may require prompt medical evaluation.
If your chest discomfort is new, different from your usual symptoms or occurs with shortness of breath, nausea, dizziness or pain that spreads to the arm, jaw, neck or back, call 911 or seek emergency medical care right away. Don’t wait to see whether an antacid relieves the symptoms or assume they will simply pass.
It’s also important to remember that heartburn and heart disease aren’t mutually exclusive — many people have both. Having a history of heartburn or acid reflux doesn’t rule out the possibility that new chest discomfort could be related to your heart. Likewise, frequent heartburn shouldn’t be ignored simply because it isn’t an emergency. Persistent reflux symptoms can signal an underlying digestive condition that may require evaluation and treatment.
If you’re unsure whether you’re experiencing heartburn or a heart problem, don’t try to diagnose yourself. It’s far better to be evaluated and learn your symptoms weren’t caused by your heart than to delay treatment for a condition that could be life-threatening.
Dr. Andrew Calvin is a cardiologist with the Mayo Clinic Health System in Wisconsin.
