Heart Attack or Heartburn?

Health, Home & Family
on February 8, 2004

A pain or burning sensation in the chest could signal a heart attack, or less life-threatening, but still potentially serious, heartburn. Anytime you experience new or unusual pains or other feelings in your chest, it’s important to seek medical attention. It’s also valuable to know the difference between the symptoms associated with a heart attack and heartburn.

Because the heart is a muscle that never rests, it’s important that the heart receive plenty of blood at all times to provide adequate oxygen and energy. In a patient with coronary heart disease, the vessels supplying blood to the heart (coronary arteries) become narrow as plaque builds up. Plaque is a sticky, fatty substance that also causes other components of the blood to become stuck to the coronary artery walls. Over a long period of time, plaque-clogged arteries narrow, reducing blood flow needed to nourish the heart. In some cases the blood supply can be cut off completely; in other people, blood clots break off and close the arteries immediately. In either case, when the blood supply decreases enough, the heart muscle is starved for oxygen and begins to die. This is a heart attack. More than 1.1 million Americans experience a heart attack each year and, as a result, nearly half of them die.

Typically, a heart attack feels like your chest is being squeezed or crushed. Some people describe the feeling as an elephant sitting on their chest. The pain often extends to the shoulder, back, throat, jaw, and arms. Most patients experience lightheadedness and have trouble catching their breath; some also have cold sweats and nausea. Exertion, exercise, or other activity usually makes the pain worse in contrast to heartburn, a condition in which rest makes the symptoms worse.

Not all heart attacks have a sudden onset. In fact, most people diagnosed with a heartattack have had symptoms for a while, beginning with mild pain or discomfort. In some cases, the discomfort subsides or goes away for a while. But, unless the problem is treated, it usually returns.

If you have severe, crushing chest pain that lasts for more than a few minutes, or other symptoms of a heart attack, call 911 and get immediate medical help. Do not be alone or isolate yourself from other people and do not drive yourself to the hospital.

Heartburn, meanwhile, is a much more common condition. More than 41 percent of adult Americans suffer symptoms of heartburn during any given month, according to a poll conducted by the Gallup Organization. In a recent survey commissioned by the American Gastroenterological Association of 1,000 patients with heartburn, nearly 80 percent had symptoms at night. For the majority, these problems were severe enough that it interfered with their sleep, affecting their work performance and quality of life the next day.

Heartburn does not actually involve your heart. The condition gets its name because the symptoms associated with it typically are located in the chest. In reality, small amounts of digestive acid escape from the stomach and move toward the throat. This acid irritates the esophagus, the tube that takes food from our throat to our stomach, and this produces the common “burning” feeling described by people who experience it. Other symptoms include a feeling that small amounts of food or liquid are coming back up. This is often accompanied by a bitter or acidy taste in the mouth.

For most people, heartburn typically occurs after eating a meal. Large meals, and certain foods, are more likely to trigger the burning sensation. Although the foods that cause heartburn are different for different people, generally foods that are high in fat, spicy or highly acidic (such as orange juice) are identified as being the culprits. Drinking alcohol or caffeine-rich beverages (coffee, soda, tea) and using tobacco products also can cause heartburn for many people. Laying down makes the pain worse for most people.

Before using any medications, try these suggestions to prevent the symptoms of heartburn:

  • Limit your intake of foods and drinks that cause or make your heartburn worse.
  • Eat smaller meals.
  • Don’t exercise immediately after a meal.
  • Don’t lie down after a meal.
  • If you are overweight, dropping some of the extra pounds may help.

The use of a liquid or tablet antacid relieves the symptoms of heartburn for many people. For others, there are a many effective non-prescription (over-the-counter) and prescription remedies available. Although they are generally considered safe and effective for most people, you should consult your physician before starting or changing any medication. If your heartburn persists, gets worse over time, does not fully go away after taking medicines, causes vomiting, appetite loss, or tarry, black stools, see a physician.

Recognize the symptoms
The list below shows some basic differences between symptoms of a heart attack and heartburn. It is not intended to take the place of a visit to, or discussion with, a qualified health professional. Furthermore, not all heart attacks occur with the same symptoms, and not all of the symptoms below have to be present.

Heart attack

  • Crushing pressure or pain in chest
  • Feeling of fullness in chest
  • Usually occurs with exercise or exertion
  • Pain may move to shoulders, back, neck arms, and jaw
  • Irregular heart rate (pulse) may occur
  • Shortness of breath
  • Cold sweats
  • Nausea
  • Vomiting
  • Lightheadedness, weakness or dizziness


  • Burning, irritation below breastbone
  • Pain usually does not move to back, shoulders, neck, arms, and jaw
  • Usually occurs after meals
  • Gets worse when lying down
  • Antacids will often make pain go away
  • Rarely causes shortness of breath, lightheadedness, dizziness, or cold sweats

Professor Al Pheley and associate professor Gail Dudley are from the Edward Via Virginia College of Osteopathic Medicine in Blacksburg, Va.