Heartburn or heart attack?

Telling heartburn from a heart attack isn’t always easy. They can cause similar chest pain sensations, and often it takes medical tests to sort out the real problem. In fact, some research suggests that more than half of people who go to the hospital complaining of chest pain don’t have heart troubles. Instead, many have heartburn.

Despite the name, heartburn has nothing to do with the heart. Heartburn occurs when acidic stomach contents creep up into the esophagus. In comparison, heart attack pain is caused by a severely decreased or complete lack of blood flow in the arteries that feed the heart muscle. Totally different problems.

The reason for the confusion: The nerves that sense pain in the heart and along the digestive tract simply aren’t that good at pinpointing the source and nature of the pain. When you have issues with your heart, your stomach, or even your gall bladder, it can register simply as “chest pain.” The symptoms are especially vague in women, older adults, and people with diabetes.

Even more confusing, heartburn can be a harbinger of a heart attack. Many women who have heart attacks say they experience heartburn or indigestion shortly beforehand.

However, there are differences that can clue you in to the cause of your pain—and guide you on how to act. Here’s a quick cheat sheet of symptoms that tend to be more common with each condition.

Heartburn hints:

• Burning pain
• Occurs after eating, especially if the meal was large, fatty, or spicy
• May move up toward the throat
• Worse when lying down or bending over
• Acidic or bitter taste in your mouth
• Usually relieved by antacids

Heart attack warning signs:

• Pressure, tightness, squeezing, or sense of fullness
• Occurs after physical exertion or during times of stress
• May spread to back, neck, jaw, shoulders, or arms, particularly on the left side
• Accompanied by shortness of breath, a cold sweat, dizziness, or nausea

Be safe, not sorry

Remember, these aren’t hard-and-fast rules. Heartburn pain sometimes will radiate to the jaw, for example, and a large meal can redirect blood flow away from the heart, contributing to a heart attack. Women and people with diabetes may have different heart attack symptoms than the ones listed, too.

“There is no absolute way to tell the difference, so if something does not feel right to you, it is better to be safe than sorry,” says Dr. Chetan Patel, a cardiologist with Greenville Health System in South Carolina. Go to the emergency room to be evaluated.

If your chest pain is more severe, feels different than usual, or your heartburn is not going away, call 911 without delay. This goes especially if you’re a woman, an older adult, have diabetes, or the pain was brought on by exercise. Be extra cautious if you have risk factors for heart disease, such as diabetes, smoking, high cholesterol, or excess weight.