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Is It Heartburn or a Heart Attack?

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Pain May Be Difficult to Distinguish | Other Causes of Chest Pain | Seeking Medical Attention for Chest Pain

rerun image The pain experienced during a heart attack and during a severe heartburn episode can be difficult to distinguish. It is not unusual for people to mistake symptoms of heart disease (such as angina and even a heart attack) for heartburn. Similarly, many people go to the emergency room each year out of fear that they are having a heart attack, only to find out they have severe heartburn. In fact, it often takes medical testing to make the determination.

Pain May Be Difficult to Distinguish

Here are some possible differences between the heartburn and heart attacks.

Possible Signs of Heartburn
  • A sharp, burning sensation below the breastbone or ribs
  • Burning sensation may move up toward the throat
  • Pain often occurs after eating, particularly when lying down
  • Pain that increases when bending over, lying down, exercising, or lifting heavy objects
  • Bitter or sour taste at the back of the throat
  • Symptoms tend to respond quickly to antacids

Note: Call 911 if you have any chest pain, even if you think it may be heartburn.

Possible Signs of Angina or Heart Attack
  • A feeling of uncomfortable fullness, pressure, squeezing, tightness, or pain in the center of the chest that lasts for more than a few minutes or goes away and comes back
  • Often brought on by physical exertion or emotional stress
  • Pain or discomfort that spreads to one or both arms, the back, stomach, neck, or jaw
  • Shortness of breath
  • Other symptoms such as:
    • Breaking out in a cold sweat
    • Nausea
    • Lightheadedness
    • Fainting
    • Palpitations (feeling a rapid heart beat)

Other Causes of Chest Pain

Heartburn and heart attacks are not the only conditions that can cause chest pain. Other problems that can cause chest pain include:

  • Other heart conditions, such as:
    • Pericarditis—inflammation of the sac surrounding the heart
    • Aortic dissection—rare, but dangerous condition in which the inner layers of the aorta separate
    • Coronary spasm—arteries supplying blood to the heart go into spasm, temporarily limiting blood flow to the heart muscle
  • Panic attack—periods of intense fear accompanied by anxiety, chest tightness, rapid heartbeat, rapid breathing, profuse sweating, and shortness of breath
  • Pleurisy—inflammation of the lining of the chest and lungs, which causes chest pain that increases with coughing, inhalation, or deep breathing
  • Costochondritis—inflammation of the rib cage cartilage
  • Pulmonary embolism—a blood clot lodged in the artery of the lung
  • Other lung conditions, such as
  • Muscle-related chest pain—often accompanies fibromyalgia and other chronic pain syndromes
  • Injured ribs, pinched nerves—can cause localized chest pain
  • Shingles—infection of a nerve root, caused by reactivation of the chickenpox virus
  • Gallbladder or pancreas problems—gallstones or inflammation of the gallbladder or pancreas can cause abdominal pain, which can radiate to the chest
  • Disorders of the esophagus—swallowing disorders such as esophageal spasms and achalasia (failure of esophageal muscle to relax)
  • Cancer—cancer involving the chest or that has spread from another part of the body

Seeking Medical Attention for Chest Pain

Chest pain can be difficult to interpret. Get emergency medical attention if you have any chest pain, especially if you have other signs and symptoms of a heart attack. A visit to the emergency room could save your life.


The American College of Gastroenterology


American Heart Association



Canadian Cardiovascular Society


Heart and Stroke Foundation of Canada



Gastroesophageal reflux disease. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated June 12, 2012. Accessed July 14, 2012.

Heart attack. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/HeartAttack/Heart-Attack_UCM_001092_SubHomePage.jsp. Accessed July 14, 2012.

Heartburn, gastroesophageal reflux (GER), and gastroesophageal reflux disease (GERD). National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/gerd/. Updated April 30, 2012. Accessed July 14, 2012.

ST-elevation myocardial infarction (STEMI). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated June 7, 2012. Accessed July 14, 2012.

Last reviewed July 2012 by Brian P. Randall, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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