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Healthy Balance

Heartburn or Heart Attack? When to Sound the Alarm

A woman sitting on a bench and touching her chest where she is experiencing heartburn.
Heartburn that doesn’t get better can be a sign of something more serious.

Heartburn is a very common condition that affects about 42 percent of Americans. In fact, I experienced it myself shortly after dinner last night. It is a symptom of gastroesophageal reflux that you typically feel as pain or burning in the chest. When you have heartburn, some of the acid in your stomach comes up into your esophagus, causing that pain. Taking an over-the-counter antacid can bring relief in moments.

Chest pain, however, is also a common sign of heart disease. Heart disease is life-threatening and is diagnosed in about 12 percent of Americans (according to the Centers for Disease Control and Prevention). It is one of the top causes of death for Americans. A heart attack, a condition in which the heart muscle is deprived of oxygen because of blocked blood vessels, can strike suddenly and be fatal if not treated promptly.

If you’re experiencing pain or burning in your chest, how do you know it’s just heartburn and not something more? We spoke with a pair of UVA doctors for some clarity.

Gauging That Heat

Be mindful of when symptoms occur and what other activities you were engaged in at the time. “The symptoms of reflux usually occur after a meal, in particular, acidic meals or greasy meals. Sometimes chocolate or wine can cause it,” says Brandy Patterson, MD, a member of UVA’s heart and vascular team.

“But chest pain or burning that occurs with or just after exercise or exertion, and has nothing to do with a meal, is more concerning for a problem with the heart. If you’re in that situation, the best thing to do is stop exerting yourself, sit down and rest and, if it doesn’t go away, call 911 if it’s severe or call your doctor if it’s not,” advises Patterson.

Bryan Sauer, MD, a member of UVA’s gastroenterology team, agrees. “Heartburn is in the area of the heart and lungs, so determining the cause of symptoms can be confusing. The number one thing is making sure it’s not a cardiac issue. If it’s exertional in nature, seeking immediate medical assistance and seeing your primary care doctor about it is the right thing to do.”

Heartburn or Heart Attack: Knowing the Signs

Differentiating simple heartburn from heart disease symptoms can be challenging. “Sometimes, people may have a meal and then go out for a walk. In that situation, it can be difficult to tell the difference between reflux or heart disease,” says Patterson.

“It’s hard because the symptoms might be similar,” agrees Sauer. “You may not be able to decipher them. It may even require an ECG or stress test to check if it’s your heart.”

“With reflux, patients may have a bitter taste in the mouth. With heart problems, there is no bitter taste in the mouth and no association with food,” says Patterson. “I would differentiate the symptoms in regard to meal vs. exercise, and acidic, funny taste in the mouth vs. none.”

In addition to the time of occurrence and related activity, understanding your own potential risk factors for heart disease is also helpful. “Age is an important risk factor for both men and women. A man’s chance of a heart attack increases at around age 40. However, the increased risk occurs around menopause for women.

“Other factors include gender and family history of premature coronary artery disease. These factors are not in our control, but there are many more controllable risk factors,” reminds Patterson.

Major risk factors for heart disease that we can control include:

  • Weight
  • Smoking
  • Cholesterol
  • Obesity
  • Sedentary lifestyle
  • Diabetes
  • Hypertension
  • Illegal drug use (in particular, cocaine)

But what about the pounding chest pain and collapse we’ve all seen in countless movies and TV shows? Isn’t that how heart attacks are supposed to happen?

Heartburn, Heart Attack and Gender

Not everyone experiences heart attacks the same way. “The common signs of heart attack include chest pain, pressure, tightness, squeezing or burning, and it could be in the middle or to either side of the chest,” says Patterson. “It may or may not spread to the neck, jaw, back or arm.”

Other possible symptoms of heart attack include:

  • Shortness of breath
  • Cold sweat
  • Fatigue
  • Lightheadedness or dizziness
  • Nausea and vomiting
  • Exercise intolerance
  • Other symptoms similar to heartburn and abdominal pain

In particular, gender may have an impact on potential heart attack symptoms. “Women tend to not have the typical heart attack symptoms. It can present as something that feels like heartburn,” states Sauer.

“It is more common for women to present with the atypical symptoms,” agrees Patterson. “An example would be fatigue without chest pain or shortness of breath without chest pain.”

When in Doubt, Give a Shout

Worried about your heartburn?

Find a primary care provider to answer your questions.

If you’re concerned that the burning in your chest is more than an antacid can handle, don’t hesitate to see your doctor. “If you’ve never had heartburn and you’re older, seeing your primary care doctor is the right thing to do,” says Sauer.

If you have taken antacids for what you believe is reflux and the reflux is not going away, “It’s really a no-brainer to make sure it’s not the heart first,” advises Patterson.

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