Heart Attack or Heartburn? Differences Between Types of Chest Pain


Anyone worried about chest pain should not wait to get urgent medical care. They should call for an ambulance straight away, especially if the pain is unexplained, sudden, or severe.

Heart attack pain is caused when one of the arteries supplying the heart becomes blocked. Angina is a similar chest pain caused when these arteries are narrowed by heart disease.

Heartburn is a burning pain often felt in the upper belly or lower chest. It is caused by stomach acid going back up the food pipe.

Heartburn and heart attack pain can be similar. If someone is in doubt whether pain is a heart attack, they should always call for an ambulance. If it is a heart attack, prompt medical care can be lifesaving.

What is a heart attack?

A heart attack is an event caused by disease in the coronary arteries. These blood vessels supply blood to the heart, keeping it alive with energy and oxygen.

When coronary artery disease causes a loss of blood supply to part of the heart muscle, this is a heart attack.

[Hear attack man holding chest]
A heart attack is when there is a loss of blood supply to part of the heart muscle.

A heart attack can lead to the heart stopping. This is called a cardiac arrest. Someone with cardiac arrest will not be responsive and will have nopulse.

Doctors also use the term “acute coronary syndrome” or ACS to talk about heart attack and other serious heart problems such as unstable angina.

Symptoms of a heart attack

Heart attacks can often – but not always – happen with classic symptoms:

  • Chest pain that is often described as pressure, squeezing, heaviness, tightness, fullness, or ache
  • Chest pain that feels like a very heavy weight crushing against the chest
  • Pain may come and go, but lasts for more than a few minutes

Not all heart attacks give the same symptoms. Symptoms can be mild or severe, and some people experience no symptoms at all.

The chest pain or discomfort is usually central or central-left, but it might not be. The pain may spread to other areas – to one or both arms, the neck, jaw, or upper or mid-back.

Heart attack often comes with other symptoms:

  • Breaking out in a cold sweat
  • Being short of breath
  • Feeling sick or nauseous
  • Vomiting
  • Feeling very tired or lacking in energy
  • Feeling dizzy or lightheaded

People who may be less likely to experience symptoms when having a heart attack include those of senior age or who have diabetes. These people may still show other symptoms though, such as breathlessness.

An “indigestion sensation” can be a sign of heart disease in people with diabetes especially, says Dr. Ahmed Idris for a Florida Hospital article comparing heartburn and heart attack pain. What is angina?

Angina is a type of chest pain that is similar to the pain of a heart attack.

Rather than the reduced supply of blood to the heart being caused by a coronary artery blockage, it is caused by vessel narrowing instead.

People with angina are at greater risk of having a heart attack. Anyone who has angina should be under medical care and alert to this risk.

The most common form of angina is temporary pain that goes away after rest or medication. This is called stable angina. Unstable angina raises the risk of a heart attack.

What is heartburn?

[woman with heartburn]
Though the pain is located in the chest, heartburn is not related to the heart in any way.

Heartburn is a symptom, not itself a disease. It is the sensation, usually of burning pain, caused by acid reflux. Acid reflux is the contents of the stomach splashing back up into the food pipe.

Heartburn is not related to the heart in any way. The confusion comes from the location of the pain, in the chest.

The stomach produces mucus to protect its lining from the acid that it uses to help with digestion. The food pipe lacks this protection, so acid reflux damages its lining. For many people, though, acid reflux does not cause such damage.

Why people with acid reflux experience pain is not fully understood. Acid-sensitive nerves may be involved in causing the pain.

Heartburn symptoms

Heartburn creates a burning sensation in the food pipe. This burning-type pain usually happens just above the stomach. The acid can also reach higher up, possibly even as far as the back of the mouth.

Other symptoms of acid reflux disease can go with the heartburn. These can include nausea, bloating, and belching.

Differences between symptoms of heartburn and heart attack

It can sometimes be difficult to know if symptoms are due to a heart attack or heartburn. Doctors often find making a diagnosis based on symptoms alone difficult and rely on tests.

When doctors themselves get symptoms, they can find them difficult to understand. A doctor at Harvard, for example, has told his story of heart disease.

He had a burning symptom in his upper belly whenever he exercised, but treatments for heartburn did not help. It was not until he became breathless and unable to carry on that he turned up at the hospital. Tests revealed heart disease that was close to causing a heart attack.

The main difference between symptoms is that:

  • Heartburn tends to be worse after eating and when lying down – although heart attack can happen after a meal, too
  • Heartburn can be relieved by drugs that reduce acid levels in stomach
  • Heartburn does not cause more general symptoms such as breathlessness
  • Heart attack does not cause bloating or belching, but these can happen with heartburn

Treatment for heart attack

If there is any suspicion of a heart attack, getting to an emergency room quickly is important.

Emergency doctors will consider the symptoms and examine the patient. Tests for heart attack may include:

  • ECG (electrocardiogram) – this traces the beat and rhythm of the heart by measuring its electrical activity moving from the top to the bottom of the heart
  • Stress testing – monitoring the heart, breathing, and symptoms during exercise on a treadmill
  • Echo, short for echocardiography, which is looking at the heart using ultrasound
  • X-ray, blood tests, and other investigations such as passing a dye into the heart circulation, which is called angiography
Angiography, passing dye into the heart circulation, is one way doctors test for heart attack.

Cardiac catheterization is one form of treatment. A doctor will mechanically open up narrowed arteries through the skin of the groin or arm.

A thin, flexible tube is passed along a blood vessel to the one affected at the heart. A balloon is used to widen the artery and improve flow through it. A mesh tube may be left in place, known as a stent, to keep the vessel open.

Drugs known as fibrinolytic or thrombolytic agents are another treatment option for heart attack. These medications to break down clots may be offered while a patient waits for cardiac catheterization.

Other drugs may be continued to prevent further clotting events, including blood-thinners such as aspirin and heparin.

Surgery options may include coronary artery bypass graft. Here, a surgeon grafts on a new blood vessel taken from another part of the body to bypass the blocked coronary artery

People who have suffered a heart attack will also be urged to make long-term efforts to reduce their risk of future problems. This can include lifestyle changes from dietary and exercise advice. Smokers would be advised to stop using tobacco. There may be more intensive help with such changes from a program known as cardiac rehabilitation.

Treatment for heartburn

The diagnosis of heartburn is through a combination of:

  • Evaluating the symptoms – the doctor will ask about when, how often, and how long they happen for, the level of severity, and how the problem varies and responds to meals, posture and so on
  • How the symptoms respond to treatments that suppress acid in the stomach
  • Possible imaging of the food pipe – doctors may use a camera known as an endoscope to see any damage in the food pipe lining
  • Possible pH testing of the food pipe to measure the level of acidity

Doctors often make the diagnosis based on the symptoms. The doctors can then try treatment that will confirm the diagnosis if it works.

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