Is That Pain in Your Chest Heartburn or a Heart Attack?

It’s frustrating, but true: The main symptoms of a heart attack and heartburn can be nearly indistinguishable — so much so that emergency responders often have to run tests to determine which condition you’re experiencing.

If healthcare professionals can’t always tell the difference between a life-changing medical event and a bad case of acid indigestion, how can you? Interventional cardiologist Laura Young, MD, shares some tips — and stresses that it’s always better to be safe than sorry.

Why they get mixed up

Both severe heartburn and heart attacks cause chest pain. But since the esophagus (where you feel heartburn) is so close to the heart, it’s often difficult for people to tell where their pain is coming from.

It can be even harder to tell the difference if you have a preexisting medical condition, like gastroesophageal reflux disease (GERD), that causes frequent bouts of acid indigestion.

How to tell them apart

Dr. Young says these are some of the best ways to distinguish between heartburn and a heart attack:

Describe your chest pain

Chest pain can present in many different — and unexpected — ways, depending on what’s causing it.

When you think of a heart attack, you may picture a person clutching their chest in agony. But Dr. Young says it isn’t always that dramatic — especially for women or people with diabetes.

Chest pain from a heart attack can feel like:

• Pressing
• Squeezing
• Tightening
• An ache that radiates to other parts of your body, like your arms, neck or jaw.

With heartburn, the name says it all. The chest pain you get feels like:

• Burning
• Stinging
• Aching
• It gets worse when you lay down. That’s because laying flat makes it easier for the stomach acid to flow into your esophagus.

Notice other symptoms

If you aren’t sure whether the pain in your chest is coming from your esophagus or your heart, zoom out and focus on any other physical sensations you’re experiencing. That should help you better distinguish between heartburn and a heart attack.

According to Dr. Young, the following symptoms suggest you may be having a heart attack, not severe heartburn:

• Pain in the arms, neck or jaw
• Sweating or “cold sweats”
• Unusual fatigue
• Feelings of fullness, indigestion or choking (also common with heartburn)
• Nausea or vomiting
• Lightheadedness or dizziness
• Extreme weakness
• Anxiety

Meanwhile, common signs that point to heartburn include:

• A bitter or acidic taste in your mouth
• Feeling like you have a lump in your throat (globus sensation)
• Burping
• A bloated feeling
• Regurgitation (throwing up food that looks undigested)

Try taking antacids

One of the key differences between heartburn and a heart attack is the fact that a heart attack won’t stop when you take medicine — including aspirin.

When you have a heart attack, it’s because one of the coronary arteries that provide blood to your heart is fully or partially blocked. That blockage is obstructing the flow of blood and oxygen to your heart. And there’s nothing in your medicine cabinet that will resolve it.

“Your symptoms will continue until that blockage is cleared,” Dr. Young clarifies.

Heartburn, on the other hand, should respond to medication like antacids.

“It’s important for a doctor to rule out a heart attack if heartburn medications like proton pump inhibitors or over-the-counter antacids aren’t relieving your symptoms,” Dr. Young urges.

Consider the circumstances

If you’re not sure whether you’re having a heart attack or a nasty bout of heartburn, it can be helpful to put your symptoms in context. Ask yourself these questions:

• What was happening when my chest pain started? Physical activity, stress and infections are just a few examples of circumstances that can trigger heart attacks.
• How long has it been going on? While severe heartburn can sometimes take hours to resolve, it normally takes less than an hour. And it doesn’t get worse with time. If your discomfort is building, or you’ve been feeling “off” all day, it’s worthwhile to be assessed for a heart attack.
• Does anything make the pain worse? If laying down or bending over makes your chest pain worse, it’s most likely a result of heartburn. The pain from a heart attack, on the other hand, may get worse as a result of physical activity or stress.
• When was my last meal — and what was it? Heartburn usually happens within an hour or two of eating, and is usually brought on by food that’s acidic, spicy or fatty — or by caffeinated drinks like tea, soda or coffee.
• Do I have medical conditions that raise my risk of a heart attack? Do you have high blood pressure, high cholesterol, a substance use disorder, overweight or obesity? These are just a few medical conditions that increase your heart attack risk.
• Do I have medical conditions that can impact heart attack symptoms? For example, people with diabetes tend to have fewer symptoms during a heart attack. “If you have diabetes, seek medical attention for even slight chest or stomach pain or discomfort,” Dr. Young adds.

When to see your healthcare provider

Act fast and err on the side of caution if there’s a chance something could be happening to your heart. As cardiologists sometimes say, “time is muscle.” So, don’t take more than a few minutes to decide to pick up the phone.

“Ignoring your symptoms, or trying to wait them out, is the worst thing you can do,” Dr. Young says. “Call 911 and get checked by a medical professional. If you’re having a heart attack, acting fast is key to stopping the damage and preventing long-term health effects.”

If you think you’re having a heart attack:

• Don’t try to drive yourself to the hospital. Call emergency services instead. It’s the fastest and safest way to get medical attention.
• Take an aspirin while you wait for the ambulance to arrive. Aspirin helps thin the blood. It’s especially helpful in the early stages of a heart attack.

Final thoughts

Dr. Young has one last reminder: It’s OK to be wrong. If you can’t tell whether you’re having a heart attack or heartburn, seeking help is the right choice.

“We don’t want you to have a heart attack,” Dr. Young says. “And we won’t be upset if it turns out you actually had a bad case of heartburn. It’s hard to tell them apart sometimes, and it’s always better to be safe than sorry.”