No Time for Heartburn

Heartburn or Heart Attack? How to Tell the Difference

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.
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Tammy Worth
Last Updated: June 01, 2009

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