Heart attack v/s heartburn

What is the best way to detect the difference between a heart attack and heartburn?

Severe heartburn and heart attack can be hard to tell apart. This causes patients to often confuse the two, leading to severe complications, or even death. Understand how they typically differ, and learn when to get immediate help.

Heartburn is a symptom and not a disease. A person with heartburn experiences burning sensations in the middle of the chest under the sternum, and in the oesophagus, that can extend to the neck, throat and face, which is caused by acid reflux. Heartburn has no association with the heart; it is usually misinterpreted due to the burning sensation behind the breastbone in the chest. Heartburn is a misnomer because it does not involve the heart. Acid reflux, on the other hand, is a condition when the acid and food from the stomach splashes back up into the food pipe. Other names for heartburn include indigestion, dyspepsia, acid reflux, gastroesophageal reflux disease (GERD), and acid peptic disease (APD).

A heart attack is caused by a problem in the coronary arteries. It occurs when there is a sudden blockage of an artery, obstructing the blood vessels to supply a sufficient amount of energy and oxygen to the heart muscles. It frequently produces chest pain that may radiate to the neck, jaw, and/or arms.

It is difficult to differentiate between a heartburn and heart attack based on symptoms alone. This is because the oesophagus and heart are located near each other, making it difficult to identify the actual cause of chest pain. It is essential to get diagnostic tests done to make the correct diagnosis.

If the person is experiencing pressure, tightness, pain, squeezing or an aching sensation in the chest, it is more likely that the person is having a heart attack. Such pain is often exacerbated by exercise or severe emotional stress. It may spread to the back, neck, jaw, or arms, and is often associated with sweating, dizziness, nausea, difficulty in breathing, or an irregular pulse. If the problem is related to the digestive system, the person experiences sharper pain that may be precipitated by eating a fatty or spicy meal. The reason behind experiencing such consistent pain is due to lying down immediately after eating food or eating particular foods, and overeating.

Duration of the pain is also an important factor here. While heart-related pain will usually last 5 to 10 minutes or slightly longer, the reflux sensation can last for hours.

The two main tests to diagnose heart attack are an electrocardiogram (ECG), and a test to determine the level of certain cardiac enzymes in the blood (troponins). Some of the additional tests to identify heart attack (or evidence for a potential heart attack) are echocardiogram, exercise stress tests (TMT) and coronary angiogram.

(The author is an interventional cardiologist, BGS Gleneagles Global Hospitals)