Heartburn or Heart Attack: How to Tell the Difference and When to Seek Help

Experiencing chest pain can be a distressing event, especially when it becomes difficult to distinguish whether the pain is due to heartburn (indigestion) or a more severe heart condition such as a heart attack, myocardial infarction. Both heartburn and heart attacks present with some overlapping symptomatic components, but they require entirely different responses. Understanding these differences and knowing when to seek medical assistance could be life-saving. In this article, we explore the fine details between heartburn and heart attacks, explain what these both conditions are and provide guidance on when to seek help.

Heartburn vs. Heart Attack Symptoms

Both heartburn and heart attacks cause discomfort in the chest, but the nature of the pain is different. Heartburn, also known as acid reflux or indigestion, occurs when stomach acid flows back up into the oesophagus. This creates a burning sensation behind the breastbone (sternum). This sensation often occurs after eating or lying down after a meal. It can also radiate up into the throat or even cause a sour taste in the mouth.

A heart attack, myocardial infarction, on the other hand, is a medical emergency. It involves a reduction or blockage of blood flow through coronary arteries to the heart muscle, resulting in heart tissue/myocardial damage. While heart attack pain can sometimes mimic heartburn, there are several key differences to look out for.

Listed below are the common symptoms for each condition:

Heartburn Symptoms:

• A burning sensation in the chest that may worsen when changing position or lying down
• Sour or acidic taste in the mouth
• Pain typically located behind the sternum, often following a large meal
• Relief from antacids or over-the-counter medications (such as Rennie or Gaviscon)
• Symptoms are often worse after overeating or at night, prior to falling asleep

Heart Attack Symptoms:

• Chest pain described as tightness, pressure, heaviness or squeezing
• Radiation of the pain to the arm, neck, jaw, or back
• Shortness of breath
• Cold sweats, nausea, or dizziness
• Symptoms may come on suddenly
• If symptoms build up over time, they are known as angina, and in less severe form occur on exertion and are relieved by rest
• No relief from antacids or heartburn medications
• Light-headedness or dizzy spells 
• Patients often but not always have one of the following risk factors of Coronary Artery Disease: smoking cigarettes, high blood pressure, diabetes, high cholesterol or family history of heart attacks.

How to Know if It’s Heartburn or Heart Attack?

Given the overlapping symptoms, how can you tell the difference between heartburn and a heart attack? Although from symptoms alone, you can never be certain, below are some of the key distinguishing factors:

1. Nature of the Pain: Heartburn pain typically has a burning sensation and is localized to the chest and throat, while heart attack pain feels like pressure or heaviness.
2. Relief from Medications: Heartburn usually improves with antacids or acid-suppressing medications like proton pump inhibitors (PPIs). Heart attack pain does not improve with these medications.
3. Position and Movement: Heartburn pain often worsens when lying down or bending over, whereas heart attack pain may persist regardless of position.
4. Duration: Heart attack pain often lasts more than a few minutes and may come and go. Heartburn pain tends to resolve more quickly, especially with treatment.

However, as mentioned above, there is always a chance that these symptoms can be misleading. It is critical to seek medical attention when in doubt, including going to AE or calling for an ambulance. 

When to Worry About Heartburn

Heartburn is common and affects many people, especially after large meals, spicy foods, or late-night overeating. However, certain heartburn symptoms can be a sign of something more serious, such as gastroesophageal reflux disease (GORD/GERD) or even a heart problem.

When to worry about heartburn and seek medical attention:

• Frequent episodes: If you experience heartburn more than twice a week, it may indicate GORD (GERD), a chronic digestive disorder that can lead to complications with time.
• Severe heartburn symptoms: Heartburn that causes intense pain, difficulty swallowing, or vomiting blood requires urgent medical attention. These may be signs of oesophagitis, an inflammation of the oesophagus, or a more serious underlying condition, including malignancy. 
• Heartburn and cardiovascular risk: As already illuded earlier, if you have risk factors for heart disease, such as high blood pressure, diabetes, obesity, high cholesterol, smoking history or a family history of heart disease, chest pain should never be dismissed as simple heartburn. It`s always to have symptoms checked by a health care professional when in any doubt. 

Belching can also sometimes mimic angina (chronic furring up of coronary arteries) as described in this case study published in 2007. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3074882/) 

Severe Heartburn Symptoms

Severe heartburn can be a very unpleasant, debilitating condition, which can affect your quality of life. Some symptoms to watch for include:

• Intense burning or discomfort in the chest, especially after meals
• Difficulty swallowing or a feeling of food being stuck in the throat
• Chronic cough or hoarseness due to acid irritation in the throat
• Regurgitation of food or stomach contents
• Unexpected weight loss or signs of malnutrition
• Fullness and a feeling of a mass in a throat of oesophagus

Severe symptoms of indigestion/heartburn may indicate Gastro-Oesophageal Reflux Disease, which can lead to complications such as Barrett’s oesophagus—a condition where the oesophageal lining changes and increases the risk of oesophageal cancer. This article describes in details the association between GORD (GERD), Barrett`s oesophagus and the development of oesophageal adenocarcinoma. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9543729/) 

Chest Pain from Heartburn

Chest pain from heartburn/indigestion is typically sharp and has the below features. Unfortunately it can sometimes mimic the pain of a heart attack, myocardial infarction. The main difference is that heartburn pain:

• Occurs after eating or drinking certain foods
• Gets worse when lying down or bending over
• Is relieved by antacids

However, if you experience new or unexplained chest pain, especially if it’s accompanied by shortness of breath, nausea, or pain radiating to the arm or jaw, you should call an ambulance or seek emergency medical care, by attending your local Accident and Emergency Department.

Unfortunately misinterpretation of symptoms as gastrointestinal issues like heartburn, instead of myocardial ischaemia (heart attack symptoms) may delay life-saving treatments . This underscores the importance of seeking help if there is any doubt.

GORD and Heart Health

GORD (GERD) and heart health are closely linked, with overlapping symptoms and complications. GORD (GERD) is a chronic condition where stomach acid frequently flows into the oesophagus, causing irritation and potentially inflammation. While GORD (GERD) is localised in a different part of the body and in itself is not directly responsible for heart attacks, there is evidence suggesting that it can exacerbate heart problems, for instance occurrence of Atrial Fibrillation. Atrial Fibrillation is a common heart arrhythmia, which in some patients increases the risk of ischaemic stroke. 

A review article, published in 2020 in a medical journal, called Cureus described several mechanism how this interaction can occur, due to inflammatory process or sympathetic vagal imbalance. In addition to this, a large hiatus hernias can cause a direct compression of the left atrium and as a result predispose to higher risk of atrial fibrillation. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7550002/) 

Medical professionals often recommend heartburn relief for cardiac patients by managing GORD (GERD) symptoms through diet modification, certain medication, and lifestyle changes, including avoidance of large meals. Over-the-counter, widely available antacid medications may not be sufficient for everyone.

Heartburn Relief for Cardiac Patients

For cardiac patients, managing heartburn safely is crucial. Certain heart medications, such as calcium channel blockers (Diltiazem) and nitrates (Isosorbide mononitrate), can relax the lower oesophageal sphincter. Although these medications can help with oesophageal spasm, they can make the reflux symptoms worse. Patients should discuss their medications with their supervising clinician to ensure they do not exacerbate reflux.

Heartburn relief strategies include:

• Elevating the head of the bed: This reduces the risk of nighttime acid reflux.
• Eating smaller meals: Large meals increase pressure on the stomach, leading to reflux and occurrence of unpleasant symptoms.
• Avoiding trigger foods: Common heartburn triggers include spicy foods, caffeine, alcohol, and fatty meals.
• Weight management: Obesity is a significant risk factor for both GORD and also diabetes and heart disease.

Proton pump inhibitors (PPIs), such as Omeprazole, Lansoprazole or Esomeprazole are commonly prescribed for GORD (GERD). A recent meta-analysis published in 2022 concluded: ` The overall results of this meta-analysis showed that long-term PPI use was not associated with an increased risk of adverse cardiovascular events. However, inconsistent results were found for combined PPI/clopidogrel therapy. These results should be considered with caution in light of the significant heterogeneity, the limited number of included studies, and the lack of adjustment for potential confounders.` (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9322047/) 

Identifying Heartburn Signs

Identifying heartburn signs early can help prevent complications in a long term. Heartburn is often triggered by specific foods, eating habits, or stress. Recognizing these patterns can help you avoid future episodes.

Common heartburn signs include:

• A burning sensation in the chest after eating
• Difficulty swallowing, which can be a symptom of a more serious health problem
• Pain that worsens when lying down or bending over
• Bitter or sour taste in the mouth
• Chronic throat irritation

Patients with frequent heartburn should consult a doctor to rule out GORD or other underlying conditions, which sometimes can prove to be serious and early recognition life saving. 

Heartburn Prevention Tips

Preventing heartburn is often a matter of lifestyle adjustments. The following heartburn prevention tips can help reduce episodes:

• Eating smaller portions: Overeating puts pressure on the stomach and can trigger reflux.
• Avoiding lying down immediately after eating: Bring the last meal forward and waiting at least 2-3 hours before going to bed after a meal can help. 
• Identifying and avoiding trigger foods: Spicy foods, citrus, chocolate, caffeine, and fatty foods are common culprits, although this often varies between patients. 
• Maintaining a healthy weight: Extra weight puts pressure on the stomach, increasing the likelihood of reflux. This is a commonly seen trigger of indigestion symptoms. 
• Quitting smoking: Smoking weakens the lower oesophageal sphincter, making acid reflux more likely. This is a well known association with a study published in 1990 in Gut journal concluding: `cigarette smoking probably exacerbates reflux disease by directly provoking acid reflux and perhaps by a long lasting reduction of lower oesophageal sphincter pressure.` (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1378332/) 
• Reduce stress: Stress increases stomach acid production and can exacerbate heartburn. The authors of this article published in 2023 concluded: `Individuals exposed to higher levels of stress are more likely to have GERD symptoms. Therefore, stress reduction should be an important part of GERD symptom management.` (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10635461/)

Heartburn and Cardiovascular Risk

The connection between heartburn and cardiovascular risk is not fully understood, but some research suggests a link. As mentioned above GERD can be a risk of developing Atrial Fibrillation. Some studies even suggest a link between GERD and Coronary Artery Disease (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5058831/). 

This review article named: `Heartburn’s Hidden Impact: A Narrative Review Exploring Gastroesophageal Reflux Disease (GERD) as a Cardiovascular Disease Risk Factor` and published in 2023 describes the link between Gastroesophageal Reflux Disease and Heart problems. Please let us know in the comments below, if you would like us to break this article down into more details. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10706980/pdf/jcm-12-07400.pdf) 

Conclusion

Understanding the differences between heartburn and heart attack symptoms is critical for timely intervention. While heartburn is often harmless and can be managed with lifestyle changes, it can sometimes mask serious cardiac events. By learning to recognize the signs of both conditions and knowing when to seek medical attention, you can protect your heart and overall health. When in doubt, always err on the side of caution and seek emergency care for unexplained or severe chest pain. Prevention is also key; simple changes to your diet, lifestyle, and medication routine can significantly reduce heartburn episodes and improve your heart health. 

Dr Bart Olechowski sees private cardiology patients with chest pains in his clinics, which are located in Winchester at Sarum Road Hospital, in Basingstoke at Candover Clinic, in Farnham at Spire Clare Park Hospital and in London on Saturday morning. During the heart consultations a range of diagnoses can be reached, which include angina, heart failure, atrial fibrillation and heart valve disease. His personal assistant, Amy Rossiter can be contacted on 07984 245 550 or via an email pa@drbart.co.uk. Additional blog posts can also be found on our Winchester & Basingstoke Cardiology website, https://www.winchesterandbasingstokecardiology.co.uk/heart-health-advice , where Dr Bart writes weekly blog posts based on latest research articles.