Anyone who is 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.
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.
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.
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 no pulse.
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 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. It can affect 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
- 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 older people and those with diabetes. These people may still show other symptoms though, such as breathlessness.
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.
Heartburn is a symptom, not 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 can damage 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 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.
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.
Sometimes even doctors can find their symptoms 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 sought medical help. 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, but a heart attack can happen after a meal, too.
- Heartburn can be relieved by drugs that reduce acid levels in the 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.
The Centers for Disease Control and Prevention (CDC) say that anyone who has the
- Chest pain or discomfort, such as pressure, squeezing, pain, or fullness that lasts more than a few minutes or that goes away and comes back again
- Pain or discomfort in other parts of the body, for example, one or both arms, back, jaw, neck, or stomach
- Shortness of breath, before or with chest discomfort
- Cold sweat
- Nausea and dizziness
- Other signs: Feeling unusually tired
All these symptoms can affect both men and women, but:
- women are more likely to experience jaw pain, nausea and vomiting, and other symptoms
- chest pain is more likely to be a dominant symptom in men
If there is any suspicion of a heart attack, getting to an emergency room quickly is important.
When to see a doctor for heartburn
People who experience acid reflux should make an appointment to see a doctor if:
- the condition persists for some time
- food “sticks” in the throat
- there is difficulty eating
- weight loss
- there is blood in the stools
- there is difficulty breathing or swallowing
Persistent exposure to the stomach acid can cause damage to the esophagus.
- aspirin to stop the blood from clotting
- nitroglycerin to improve blood flow
- oxygen therapy
- treatment for chest pain
Emergency doctors will consider the symptoms, examine the patient, and carry out some tests.
Tests for heart attack
- ECG: 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: This involves monitoring the heart, breathing, and symptoms during exercise on a treadmill.
- Echocardiography: “Echo” looks at the heart using ultrasound.
- X-ray, blood tests, and other investigations such as passing a dye into the heart circulation: This is called angiography.
Percutaneous coronary intervention is one form of treatment. A doctor will mechanically open up narrowed arteries by threading a small catheter through a blood vessel, usually in the groin.
A device, such as a balloon, is used to widen the narrowed artery and improve flow through it. A mesh tube, known as a stent, may be left in place, to keep the vessel open.
Drugs known as fibrinolytic or thrombolytic agents are another treatment option for heart attack. These medications are used to break down clots.
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 experienced a heart attack will also be urged to make long-term efforts to reduce their risk of future problems.
This can include lifestyle changes, such as:
- following a healthful diet that is low in fat and sugar
- getting regular exercise
- avoiding or quitting smoking
- maintaining a healthy weight
There may be more intensive help with such changes from a program known as cardiac rehabilitation.
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, the person’s posture, and so on.
- Response to treatment: This looks at how symptoms respond to treatments that suppress acid in the stomach.
- Imaging of the food pipe: A camera known as an endoscope may be used to see any damage in the food pipe lining.
- pH testing of the food pipe: This can measure the level of acidity.
Treatment will depend on the cause.
It may include:
- using medications to neutralize the acid or reduce production
- lifestyle changes, for example, eating smaller, more frequent meals
- avoiding foods that trigger reflux
- not eating 2 to 3 hours before sleep
- maintaining a healthy weight
- not smoking
The individual’s account of the symptoms is often enough to make a diagnosis and prescribe treatment. If the treatment does not work, the person should seek further advice.
Learn more about the warning signs of a heart attack.