You may have wondered at one time or another whether you might be having a heart attack. While many people think the movie image of a person slumped over and clutching his chest is typical of a heart attack, that's often not the case. Some people having a heart attack complain primarily of heartburnlike pain or an upset stomach rather than crushing chest pain. Although both conditions are associated with chest pain or discomfort, doctors use a variety of methods to differentiate between heartburn and a heart attack -- including the character of the symptoms, tests and even responses to medications.
Symptom Characteristics and Companions
Both heartburn and a heart attack commonly cause chest pain, which might radiate to the jaw or arm. The character of the pain and accompanying symptoms provide clues about the more likely cause. For example, burning chest pain accompanied by a sour or bitter taste in the mouth and burning in the back of the throat points toward heartburn. These symptoms relate to acidic stomach contents traveling up the esophagus into the back of the mouth. On the other hand, chest pain accompanied by shortness of breath, sweating and/or dizziness suggests the underlying problem is more likely a heart attack. Of course, the presence or absence of certain symptoms is insufficient to determine whether chest pain is due to a heartburn or a heart attack. Testing and further evaluation is necessary.
During a heart attack, a portion of the heart is not receiving adequate blood and is starved for oxygen. This leads to predictable changes in the heart's electrical activity, which can be detected by an electrocardiogram, or ECG. In contrast, acid reflux alone causes no changes in the heart's electrical activity. Therefore, a normal ECG in someone who is having chest pain indicates a heart attack is a less likely cause of the pain. A normal ECG alone is helpful but is not enough to be certain that the symptoms are due to heartburn rather than a heart attack. Depending on the situation, blood tests, imaging of the heart and its blood supply, a stress test, or other tests or procedures may be needed.
Stomach Acid Suppression
Antacids -- medicines that neutralize stomach acid -- typically reduce symptoms related to heartburn within a few minutes but are unlikely to significantly relieve symptoms of a heart attack. Because heartburn symptoms relate to the corrosive nature of stomach acid, neutralizing the acid usually leads to rapid symptom relief. If symptoms resolve after taking an antacid, then it is more likely that heartburn rather than a heart attack is the underlying cause. Examples of antacids include:
-- Calcium carbonate (Tums Ultra, Tums Smoothies).
-- Aluminum hydroxide/magnesium carbonate (Gaviscon Extra Strength Liquid, Gaviscon Extra Strength Tablets).
-- Aluminum hydroxide/magnesium hydroxide (Maalox).
-- Aluminum hydroxide/magnesium hydroxide/simethicone (Mylanta, Mygel).
Warnings and Precautions
Chest pain can signal a potentially life-threatening heart attack or another serious condition. If you're having chest pain and aren't sure of the cause, seek emergency medical care. It can be very challenging for even experienced doctors to determine whether chest symptoms are due to a heart attack, heartburn or another condition without advanced testing. The likelihood of a heart attack is higher in:
-- Men over the age of 55.
-- Women over the age of 65.
-- Anyone who has had a heart attack in the past.
If you experience chest pain with sweating, difficulty breathing, pain in the arm or into the jaw, weakness or there is any concern about a heart attack, call 911.
- American Family Physician: Outpatient Diagnosis of Acute Chest Pain in Adults
- Canadian Medical Association Journal: Gastroesophageal Reflux: Clinical Presentations, Diagnosis and Management
- World Journal of Gastrointestinal Pharmacology and Therapeutics: Diagnosis and Treatment of Gastroesophageal Reflux Disease