Heartburn or Heart Attack? How to Tell the Difference

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.

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.