When it comes to chest pain, heartburn and heart attack can be hard to tell apart, even for doctors, the Mayo Clinic says. Pain that starts in your stomach from acid indigestion can move up into your chest and feel just like a heart attack.
"Coronary heart disease causes chest pain that can be very difficult for a person to distinguish from epigastric pain caused by reflux of acid into your esophagus. Both patients and doctors need to have a high index of suspicion," says Brooks D. Cash, MD, chief of gastroenterology, hepatology and nutrition at the University of Texas Health Science Center at Houston.
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Why Heartburn Causes Chest Pain
The American Heart Association (AHA) explains that heartburn happens when stomach acids seep up into your esophagus. Your stomach lining is equipped to handle acid, but your esophagus is not. Stomach acid in your esophagus causes burning pain. It is called heartburn because your esophagus runs through your chest, very close to your heart.
Chest pain from heartburn can also cause other symptoms usually associated with a heart attack like pain that moves from your chest to your neck or jaw, says AHA. According to University of Southern California Keck Medicine, 30 to 40 percent of people who come to the emergency room with chest pain have esophageal reflux.
Is It Heartburn?
AHA says that chest pain from heartburn is very common. "The most common cause of heartburn pain is gastroesophageal reflux disease," says Dr. Cash. These are the symptoms of chest pain caused by heartburn, according to Mayo Clinic:
- Pain that starts as a burning near your stomach.
- Pain that moves up into your chest.
- Pain that is worse after eating, bending over or lying down.
- Pain relieved by taking an antacid.
- Tasting acid in your throat.
Keck Medicine adds that heartburn is more likely if you have eaten greasy or spicy food. AHA says other risk factors for heartburn are drinking alcohol, smoking and eating citrus foods.
Read more: The Dos and Don'ts of Eating With GERD
Is It a Heart Attack?
"Coronary artery disease presents as chest pain along with shortness of breath and clammy, cold sweat. It may also be triggered by exertion," says Dr. Cash. AHA also says that sweats and shortness of breath along with chest pain are more likely to be a heart attack. Cleveland Clinic adds that chest pain from a heart attack will continue after you take antacids.
Mayo Clinic says these are heart attack symptoms:
- Chest pain that feels like pressure, tightness, squeezing or aching.
- Pain in the chest or arms that spreads to your neck, jaw or throat.
- Nausea or indigestion.
- Shortness of breath.
- Cold sweats.
"Another important factor for determining if chest pain is caused by a heart attack is your risk factors for heart disease," says Dr. Cash. You may be at higher risk if you have diabetes, high cholesterol, high blood pressure, are a smoker or are overweight, says Mayo Clinic.
Other Causes of Chest Pain
Keck Medicine says these are some other causes of chest pain that can be confused with heartburn or heart attack:
- An upper respiratory infection or bronchitis can cause chest pain from congestion and mucous in your lungs. Other symptoms include fever, cough, and shortness of breath.
- An infection of your heart muscle, called myocarditis, can cause chest pain along with a rapid pulse, fever and shortness of breath.
- Stable angina is decreased blood flow to your heart that is not yet a heart attack. You may have chest pain that stops short of a heart attack. Angina may be triggered by exertion, a heavy meal, stress or smoking.
Mayo Clinic adds two digestion problems that can mimic a heart attack. Muscle spasm of the esophagus causes chest pain similar to heart attack and gallbladder pain can also spread to your chest.
Sometimes it is just too hard to tell heartburn from heart attack. If in doubt, let a doctor make the decision. Call 911.
- Mayo Clinic: “Heartburn or Heart Attack: When to Worry”
- Brooks D. Cash, MD, chief of gastroenterology, hepatology and nutrition, University of Texas Health Science Center at Houston
- American Heart Association: “Heartburn or Heart Attack?”
- Keck Medicine of USC: “Is My Chest Pain Heartburn, or Is It Something Else?”
- Cleveland Clinic: “Is That Pain in Your Chest Heartburn or a Heart Attack?”
Is this an emergency? If you are experiencing serious medical symptoms, please see the National Library of Medicine’s list of signs you need emergency medical attention or call 911.