The vexing nature of chest pain, a symptom that grabs attention, lies in its ability to masquerade as both heartburn and a heart attack. Discerning the disparity can be challenging, but understanding the varying symptoms can help mitigate heart damage in case of an actual heart attack or alleviate unnecessary panic if it turns out to be heartburn.
Gastroesophageal reflux disease (GERD) and other gastrointestinal issues like ulcers, esophageal muscle spasms, gallbladder attacks, and pancreatitis can all induce chest pain and symptoms that mimic those of a heart attack or angina—an oppressive chest pain due to reduced blood flow to the heart. Some individuals experiencing angina liken it to an elephant sitting on their chest.
According to the American College of Gastroenterology, a staggering 70 million patients (23% of the population) in the United States endure non-cardiac chest pain (NCCP). GERD stands as the leading cause of NCCP, arising from chronic acid reflux from the stomach into the esophagus.
The overlapping symptoms arise from the fact that the nerves in the stomach and heart fail to distinctly signal to the brain the origin of the pain.
“The nerves in the chest aren’t as specific as nerves in, say, the hand,” explained Dr. Stephen Kopecky, a cardiologist at the Mayo Clinic. If someone were to injure their little finger with a hammer, they could accurately identify the affected finger. However, if pain stems from the heart, lungs, pancreas, esophagus, or stomach, the sensation may be perceived merely as chest pain. This diagnostic challenge is further compounded by the fact that around half of heart attack patients experience mild or no symptoms, refraining from seeking medical attention.
While symptoms may vary depending on an individual’s specific heart or stomach condition, certain distinguishing factors can help differentiate between the two.
To differentiate heart-related issues, individuals often experience tightness, burning, or pressure in the chest. Physical exertion or intense emotional stress tends to exacerbate this pain, which can radiate to the back, neck, jaw, or arms. Additional associated symptoms include sweating, dizziness, nausea, difficulty breathing, and an irregular pulse. The likelihood of a heart-related cause increases if one possesses risk factors such as diabetes, smoking, obesity, high cholesterol, or a family history of heart disease. Age also plays a role, with heart disease being more prevalent in men over 45 and women over 55.
Duration of pain serves as another differentiating factor. Angina typically subsides within five to 10 minutes, while a heart attack may last slightly longer. Conversely, reflux-induced pain can persist for hours.
When the issue pertains to the digestive system, like GERD, the pain is often sharper and can be triggered by consuming fatty or spicy meals, exacerbated by changes in position. Lying down or bending over tends to intensify the discomfort, and stomach acid refluxing into the esophagus may cause a sour taste in the mouth.
Nevertheless, physicians caution that exceptions exist. Dr. Julius M. Gardin, chairman of the department of internal medicine at Hackensack University Medical Center, notes that some patients experience angina after a substantial meal due to diverted blood flow for digestion. Furthermore, the placebo effect can cause those having a heart attack, mistakenly assuming it to be heartburn, to feel better after taking an antacid.
Special attention must be given to atypical heart attack symptoms in women and the elderly. Dr. Myrna Alexander Nickens, a cardiologist, highlights that women may experience nausea, exhaustion, and general fatigue during a heart attack. Elderly individuals may feel faint, short of breath , or simply unwell during a heart attack. These non-traditional symptoms underscore the importance of recognizing the diverse manifestations of a heart attack in different populations.
If uncertainty lingers regarding the cause of chest pain, seeking medical evaluation is crucial. In case of chest tightness accompanied by sweating, pallor, extreme weakness, or fainting, immediate medical attention should be sought at an emergency room.
For milder or intermittent chest discomfort, an emergency visit may not be necessary, but it is still recommended to consult a doctor at the earliest convenience. A healthcare provider can perform blood tests to assess the possibility of a mild heart attack or other cardiac issues. Regular check-ups are also advised for individuals with risk factors for heart disease, even if they do not experience chest pain or discomfort. Those with specific risk factors such as diabetes and hypertension should schedule more frequent visits, as these conditions significantly increase the risk of a heart attack.
For chest pain associated with digestive issues like GERD, relief can often be obtained by using antacids. Additionally, taking aspirin, which acts as a blood thinner, may alleviate heart-related symptoms and reduce the likelihood of a heart attack or fatal outcomes. However, individuals with a known history of ulcers should exercise caution as aspirin can exacerbate bleeding in such cases.
It is important to recognize that while aspirin can worsen gastrointestinal symptoms, the potential benefits in preventing heart attacks outweigh the risks. Dr. Gardin emphasizes the critical nature of prompt treatment for a heart attack, ideally within 90 minutes of symptom onset, to minimize damage to the heart muscle. Time plays a vital role in preserving cardiac health, as every minute counts.
In summary, distinguishing between heartburn and a heart attack based on symptoms alone can be challenging due to their overlapping nature. Seeking medical evaluation is crucial for accurate diagnosis and appropriate management. Whether it’s a heart-related issue or a digestive problem, timely medical attention can help safeguard one’s health and well-being.
