Last updated: Jun 01, 2009

Three years ago, Lee Ann Williamson began feeling uncomfortable as she was playing the piano for the Sunday services at a church in a Kansas City suburb. She wasn't sure what it was—a heart problem, heartburn, or something else. All she knew was that it felt a bit like someone was sitting on her chest. She tried to ignore the chest pain and kept on playing.

However, as the morning progressed, the pain didn't go away and indeed got worse. Finally, the then-46-year-old sought out a physician who was a church member, who recommended she go straight to the emergency room.

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At the hospital, her blood pressure was a very elevated 186 over 110 and she was given nitroglycerin, a drug that relaxes blood vessels and can often help restore blood flow to the heart in heart attack patients. The medication gave her a whopping headache, a common side effect of the drug. Then the ER staff told her that she was not, in fact, having a heart attack. Further testing showed that Williamson was suffering from acid reflux and had inflammation in her esophagus—a sign of gastroesophageal reflux disease, or GERD.

Williamson's experience is not an uncommon one; chest pain can turn out to be a heart attack or a less serious condition, such as heartburn—but it can be really tough to tell the difference. However, the symptoms do differ. The more you know, the easier it is to avoid heart damage if chest pain does turn out to be a heart attack or unnecessary panic if it doesn't.

Brain can mix-up pain signals from chest, stomach
GERD and other gastrointestinal problems such as ulcers, muscle spasms in the esophagus, a gallbladder attack, and pancreatitis can all cause chest pain and other symptoms that mimic those of a heart attack or angina, a crushing type of chest pain caused by decreased blood flow to the heart. Some people with angina say it feels like an elephant is sitting on their chest.

About 300,000 new cases of noncardiac chest pain are diagnosed annually in the United States, according to the Mayo Clinic. Studies have shown that anywhere between 22% and 66% of patients with noncardiac chest pain have GERD, which is caused by chronic acid reflux from the stomach into the esophagus.

The ambiguity in symptoms is caused by the fact that the nerves in the stomach and heart don't clearly signal to the brain where pain originates.

Nerves in the chest are not as specific as nerves in, say, the hand, says Stephen Kopecky, MD, a cardiologist at the Mayo Clinic in Rochester, Minn. Dr. Kopecky says if someone were to get hit with a hammer on their little finger, the person would be able to identify which finger was injured. But if someone were hurt in the heart, lungs, pancreas, esophagus, or stomach, in each case they may just feel pain coming from the chest.

"This makes for a real problem when diagnosing," he says. "And about half of patients who have a heart attack have minor symptoms (or no symptoms) and do not seek medical attention."

Although every individual may experience varying symptoms depending on their stomach or heart condition, there are some ways to differentiate between the two.

Other risk factors, timing of pain are key
If the problem is heart-related, you will likely feel a tightness, burning, or pressure in your chest. This pain is often exacerbated by exercise or severe emotional stress. It may spread to the back, neck, jaw, or arms, and is often associated with sweating, dizziness, nausea, difficulty breathing, or an irregular pulse.

The culprit is also more likely to be heart-related if you have risk factors including diabetes, smoking, obesity, high cholesterol, or a family history of heart disease. Age plays a role as well: Heart disease is more common in men over 45 and in women over 55.

Duration is another factor, says Myrna Alexander Nickens, MD, a cardiologist at Jackson Cardiology Associates in Jackson, Miss. She says angina will usually last five to 10 minutes before subsiding, a heart attack with be slightly longer, and reflux can last for hours.

If the problem is related to the digestive system, like GERD, it is often a sharper pain that may be precipitated by eating a fatty or spicy meal and is affected by change in position. (It will get worse when lying down or bending over). Stomach acid may come up into your esophagus and can leave a sour taste in your mouth.

But physicians caution that there are always exceptions to any of these rules of thumb. Julius M. Gardin, MD, chairman of the department of internal medicine at Hackensack University Medical Center in Hackensack, N.J., says some patients get angina after eating a big meal because blood flow is diverted from the heart for digestion. And, due to the placebo effect, people who are having a heart attack and mistakenly believe they are experiencing heartburn may actually feel better after taking an antacid, says Dr. Gardin.

Women and elderly people are more likely than younger men to have unusual heart attack symptoms, Dr. Alexander Nickens says. Women may have nausea, exhaustion, and a generalized tired feeling when they're having a heart attack. Elderly people may feel faint, out of breath, or just generally bad.

When in doubt, get it checked out
If you have symptoms that you are unsure about, see a physician. And go to the emergency room if you have chest tightness, break into a sweat, turn pale, become very weak, or faint.

If you have chest discomfort that's mild or passes when you're at rest, an emergency visit may not be necessary, but Dr. Alexander Nickens recommends seeing a doctor as soon as possible. A physician can use a blood test to see if you've had a mild heart attack or other heart problems.

She also recommends annual checkups for anyone with heart disease risk factors even if they aren't having any chest pain or discomfort, and more frequent visits for those with specific risk factors such as diabetes and hypertension, which is particularly likely to increase the risk of heart attack.

If you have chest pain that seems to be stomach-related, antacids should improve symptoms. And taking an aspirin, which is a blood thinner, may bring relief for those suffering from heart problems and decrease the chance of having a heart attack or death, Dr. Alexander Nickens says.

If you experience severe chest pain and you aren't sure what's causing it, Gardin recommends chewing an aspirin and seeking medical care. (An important exception, he says, is people who have a known history of ulcers, since aspirin can make ulcers bleed.) Although aspirin can make gastrointestinal symptoms worse, it's the lesser of two evils. "There is a risk-benefit calculation that one would make," says Dr. Gardin. "The theory is that more people die of heart attacks than reflux."

If a heart attack is treated promptly—within 90 minutes of when symptoms start—the damage to heart muscle may be minimized. "In terms of a heart attack, time is muscle," Dr. Gardin says.