Dear Dr. Garner,
I frequently get heartburn after heavy meals. I am always a little worried about how to tell the difference between heart pain and indigestion.
I lost my best friend to a heart attack. He thought he was experiencing some indigestion.
Is there any way to know for certain when it is a heart attack?
Getting to the Heart of the Matter in Midwood
Dear Heart of the Matter,
Your question is important, especially at this time of the year when the most number of heart attacks occur. They could be due to stress, overeating and overindulging of alcohol.
Many of these heart attacks come with warnings and unfortunately, they are all too often ignored.
I would like to review the typical symptoms of heart attacks and then contrast them with those one gets from heartburn. A caveat is that there is no guaranteed way to know a heart attack from heartburn. It is always better to make an error and an unnecessary trip to the emergency room, rather than dying from something that could have been avoided.
Most of the deaths from heart attacks are caused by a fatal heartbeat irregularity. If you are in the hospital, the heartbeat can be quickly made normal and death avoided.
Heartburn and chest pain are very different, but can feel very much the same. Learning to tell the difference between heartburn and something more serious may be a matter of life and death.
What is heartburn? One of the symptoms of heartburn is a burning feeling over the heart and hence its name. It usually occurs after eating or while lying flat or bending over. It can be brief or last for a few hours.
Heartburn is caused by stomach acid backing up into the esophagus. Normally, the esophagus has a valve just before it attaches to the stomach that prevents stomach acid from backing up. When it malfunctions, heartburn occurs. There may be an unpleasant taste in the mouth from the stomach acid.
Persistent heartburn may point to a more serious condition called acid reflex or GERD. This can lead to cancer if left untreated.
Heartburn can also be caused by an inflamed stomach lining (gastritis), an ulcer or a hiatus hernia (where the stomach is located in the chest).
Gall bladder disease (stones) can also cause chest pain, but this is usually related to a fatty meal and usually occurs on the right side of the chest.
It can be very difficult to differentiate heartburn from a heart attack. Here are some signs which may signal a heart attack:
• Sudden pressure or crushing pain in the center of the chest that lasts more than a few minutes
• A pain spreading though the back, neck, jaw, shoulders or arms – especially the left arm
• Chest pain that is accompanied by shortness of breath, sweating, dizziness, nausea or vomiting
Some of the symptoms that point to a diagnosis of heartburn are:
• Burning and irritation are felt below the breastbone.
• The pain usually doesn’t move to the back, shoulders, neck, arms and jaw.
• The pain usually occurs after meals or when lying down.
• Antacids will often make the pain go away.
• It rarely causes shortness of breath, lightheadedness, dizziness or cold sweats.
If the heartburn seems worse or different than normal, especially if it occurs during exertion or exercise, and it is accompanied by shortness of breath, sweating or pain in the left shoulder and arm, get help. Call 911 or if there is someone who can drive, get to the hospital as soon as possible.
Heart attacks can come on at any time but if the pain is related to exercise or emotional stress, then it is much more likely.
On the other hand, if pain is worse lying down, bending forward or straining and gets better when standing up, swallowing water or taking antacids, then heartburn is more likely.
If there are any unusual symptoms, don’t delay in seeking medical help. It just might save your life.
Dr. Garner is a Fidelis Care provider who is affiliated with New York Methodist Hospital, Park Slope. He also hosts “Ask the Doctor” on NET TV, Tuesdays at 8 p.m. on Time Warner Channel 97, Cablevision Channel 30 and Verizon FiOS on Demand.