Is It Heartburn or a Heart Attack?
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Is It Heartburn or a Heart Attack?

rerun image Richard had been battling digestive problems for most of his life. So when the 78-year-old developed persistent discomfort in the chest, he assumed it was just another severe case of heartburn . For several weeks, he tried antacids and other treatments, without relief.

One day on the golf course, Richard complained about the discomfort. His golf partner, a retired cardiologist, urged Richard to get immediate medical attention. What he thought was heartburn was actually angina. And, despite having low cholesterol level, Richard had two severely blocked coronary arteries. It was recommended that he have emergency bypass surgery.

Pain May Be Difficult to Distinguish

It’s not unusual for people to mistake symptoms of heart disease (such as angina and even a heart attack ) for heartburn. Similarly, many people go to the emergency room each year out of fear that they’re having a heart attack, only to find out they have severe heartburn. The pain experienced during a heart attack and during a severe heartburn episode can be difficult to distinguish. In fact, it often takes medical testing to make the determination.

In addition to some similar symptoms, both heartburn and heart attacks are more likely to occur in people over the age of 40. Here are some possible differences between the two conditions.

Possible Signs of Heartburn

  • A sharp, burning sensation below the breastbone or ribs
  • Burning sensation may move up toward the throat
  • Pain usually doesn’t radiate to the shoulders, arms, or neck (although it can)
  • Pain often occurs after eating, particularly when lying down
  • Pain that increases when bending over, lying down, exercising, or lifting heavy objects
  • Bitter or sour taste at the back of the throat
  • Symptoms tend to respond quickly to antacids

Note: Call 911 if you have any chest pain, even if you think it may be heartburn.

Possible Signs of Angina or Heart Attack

  • A feeling of uncomfortable fullness, pressure, squeezing, tightness, or pain in the center of the chest that lasts for more than a few minutes, or goes away and comes back
  • Pain or discomfort that spreads to one or both arms, the back, stomach, neck, or jaw
  • Pain often responds quickly to nitroglycerin
  • Shortness of breath
  • Other symptoms such as:
    • Breaking out in a cold sweat
    • Nausea
    • Lightheadedness
    • Fainting
    • Palpitations (feeling a rapid heart beat)

Other Causes of Chest Pain

Other problems that can cause chest pain include:

  • Other heart conditions, such as:
    • Pericarditis—inflammation of the sac surrounding the heart
    • Aortic dissection—a rare, but dangerous condition in which the inner layers of the aorta separate
    • Coronary spasm—arteries supplying blood to the heart go into spasm, temporarily limiting blood flow to the heart muscle
  • Panic attack—periods of intense fear accompanied by anxiety, chest tightness, rapid heartbeat, rapid breathing, profuse sweating, and shortness of breath
  • Pleurisy—inflammation of the lining of the chest and lungs, which causes chest pain that increases with coughing, inhalation, or deep breathing
  • Costochondritis—inflammation of the rib cage cartilage
  • Pulmonary embolism—a blood clot lodged in the artery of the lung
  • Other lung conditions, such as
  • Muscle-related chest pain—often accompanies fibromyalgia and other chronic pain syndromes
  • Injured ribs, pinched nerves—can cause localized chest pain
  • Shingles—infection of a nerve root, caused by reactivation of the chickenpox virus
  • Gallbladder or pancreas problems—gallstones or inflammation of the gallbladder or pancreas can cause abdominal pain, which can radiate to the chest
  • Disorders of the esophagus—swallowing disorders such as esophageal spasms and achalasia (failure of esophageal muscle to relax)
  • Cancer—cancer involving the chest or that has spread from another part of the body

Seeking Medical Attention for Chest Pain

Chest pain can be difficult to interpret. Get emergency medical attention if you have any chest pain, especially if you have other signs and symptoms of a heart attack. A visit to the emergency room could save your life.


The American College of Gastroenterology

American Heart Association


Canadian Cardiovascular Society

Heart and Stroke Foundation of Canada


Heartburn, gastroesophageal reflux (GER), and gastroesophageal reflux disease (GERD). National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: h Updated May 2007. Accessed July 2, 2008.

Heartburn overview. National Heartburn Alliance website. Available at: Accessed July 2, 2008.

What is a heart attack? American Heart Association website. Available at: Updated April 2008. Accessed July 2, 2008.

Last reviewed June 2008 by Michael J. Fucci, DO

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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