How do I differentiate between Heart Attack and severe heart burns because of Acidity?

This is a great question, and represents a dilemma that occurs frequently in cardiology practice. It can be quite tricky to distinguish between chest pain arising from the heart, and pain resulting from the reflux of stomach acid into the esophagus. Major clues can usually be found in the patient history. Chest pain arising from blockages in the major arteries to the heart indicates that a patient may be having a heart attack, or is presently suffering from the effects of blockages and is at risk of heart attack sometime in the future. Such “cardiac chest pain” is frequently felt as a sensation of chest tightness or pressure (often described as ‘an elephant on my chest’), which often is worse with exertion and which may spread to the jaw and arms. Cardiac chest pain MAY also have less typical features, including symptoms of shortness of breath, fatigue, nausea and indigestion. Such atypical features are more common in women and deserve intense evaluation.


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“Heartburn”, resulting from the reflux of stomach acid into the esophagus, is frequently felt as a burning sensation in the chest. Heartburn is frequently felt after eating a large meal (when the output of stomach acid is increased), and may be worse at night after laying down, when it may be easier for stomach acid to flow back into the esophagus. Drinking alcohol in the evening also leads to heartburn, as alcohol causes the esophagus to dilate, facilitating the entry of stomach acid. Heartburn may also be felt as a lump in the throat, nausea or vomiting, breathing problems, and bad breath. Heartburn sometimes gets better with sitting up, drinking carbonated water, or burping.



Clearly there is overlap between “heartburn” symptoms and cardiac chest pain, which may represent a heart attack! Any concerning chest pain should be reported to a cardiologist. If you believe you are having a heart attack, it is best to call 9-1-1 for an ambulance to take you to a hospital for emergency evaluation. For concerning symptoms that are not urgent or critical in nature, medications can be used to inform on the origin of symptoms. Symptoms that improve with antacid medications (ie, omeprazole [Prilosec], lansoprazole [Prevacid], pantoprazole {Protonix]) suggests the heartburn is present. Chest pain that improves with nitrate therapy (ie, isosorbide mononitrate [Imdur]) is likely to be of cardiac origin.


Symptoms of False Heart Attack
– Pain in the chest
– Heartburn
– Stomach pain
– Panic attacks or extreme stress
– Gall bladder attack


Symptoms of “heart attack” may also be due to heartburn, or reflux of stomach acid into the esophagus. 



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