Heartburn or Heart Attack: Is it a Misdiagnosis?

Chest pain is a symptom that demands attention, as it can indicate a serious condition like a heart attack. However, it can also be caused by less severe issues like heartburn. Nevertheless, it can be difficult to distinguish between the two. It's important to know the difference to avoid serious heart damage or unnecessary panic.

Non-cardiac chest pain (NCCP) affects as many as 70 million patients (23% of the population) in the United States, according to the American College of Gastroenterology. Gastroesophageal reflux disease (GERD) is the most common cause of NCCP, and other gastrointestinal issues like ulcers, muscle spasms in the esophagus, a gallbladder attack, or pancreatitis can also cause chest pain similar to that of a heart attack or angina (a crushing pain caused by decreased blood flow to the heart).

The issue with chest pain is that stomach and heart nerves don't clearly signal pain origin to the brain. This makes diagnosis difficult, and about half of heart attack patients have minor symptoms or no symptoms and don't seek medical attention.

There are some ways to differentiate between heart-related and digestive-related chest pain. Heart-related pain is characterized by tightness, burning, or pressure in the chest that worsens with exercise or severe emotional stress and may spread to the neck, arms, back, or jaw. It's more likely to be heart-related if you have risk factors like diabetes, smoking, obesity, high cholesterol, or a family history of heart disease, and if you're older than 45 as a man or 55 as a woman. Angina lasts 5-10 minutes before subsiding, while a heart attack may last slightly longer. Digestive-related chest pain like GERD is often a sharp pain that gets worse when lying down or bending over after eating a fatty or spicy meal and may leave a sour taste in your mouth.

There are always exceptions, and women and elderly people are more likely to have unusual heart attack symptoms like nausea, exhaustion, fainting, feeling faint or out of breath, or a generalized tired feeling. If you're unsure about your symptoms, see your healthcare provider, and go to the emergency room if you have chest tightness, break into a sweat, turn pale, become very weak, or faint. Even if you have mild chest discomfort that passes at rest, see a doctor as soon as possible.

Annual checkups are essential for those with heart disease risk factors like diabetes and hypertension.

If you have chest pain that seems to be stomach-related, antacids should improve symptoms. And taking aspirin, which is a blood thinner, may bring relief for those suffering from heart problems and decrease the chance of having a heart attack or death, said Dr. Alexander Nickens.

If you experience severe chest pain and you aren't sure what's causing it, Dr. Gardin recommended chewing aspirin and seeking medical care. An important exception, he said, is people who have a known history of ulcers, since aspirin can make ulcers bleed.

Although aspirin can make gastrointestinal symptoms worse, it's the lesser of two evils. 'There is a risk-benefit calculation that one would make,' said Dr. Gardin. 'The theory is that more people die of heart attacks than reflux.'

If a heart attack is treated promptly—within 90 minutes of when symptoms start—the damage to the heart muscle may be minimized. 'In terms of a heart attack, time is muscle,' said Dr. Gardin.