Is Your Heart on Fire or Failing?

Heartburn or heart attack? Both conditions have the word heart in them, but they are different clinical entities. Heartburn is due to digestive acid from the stomach that may reflux back into the esophagus. Reports indicate that up to 15 million Americans have symptoms of heartburn daily. A heart attack occurs in the setting of coronary artery disease leading to diminished blood flow to the heart. Coronary artery disease affects up to 20 million individuals in the United States and close to one million individuals will have a heart attack each year. Since the stomach and heart are both in the chest area, both can present with chest pain or to some even as acid reflux.

The ambiguity of symptoms is because the nerve endings in the stomach and heart are not as specific, so any discomfort in the area can be described by patients as chest pain. There are some generalizations about how to differentiate between simple heartburn versus the more serious condition of a heart attack, but it can still be challenging.

Features of heartburn usually include:

• Burning sensation in the upper abdomen that may move up into the chest
• Occurs after eating or while lying down or bending over
• May awaken from sleep especially if eaten within few hours of going to sleep
• Can relieve by antacids
• May have sour taste in the mouth
• May have regurgitation of small amount of stomach contents rising into back of the throat

A heart attack and cardiac chest pain can have various clinical presentations, but the general “textbook” features include:

• Pressure, tightness, squeezing pain in the chest that can radiate to the neck, jaw, or back pain triggered by exertion
• Associated nausea, vomiting, shortness of breath, headache, dizziness, fatigue, or cold sweats
• May have other associated medical problems such as high blood pressure, high cholesterol, or diabetes

The management for heartburn and a heart attack are very different. Heartburn can generally get help with medications and most patients will ultimately undergo an upper endoscopy. In severe cases of heartburn, endoscopic or surgical management, you can look at other options. A heart attack is a life threatening event and needs to be promptly managed by a cardiologist.
When any patient has symptoms of chest pain or acid reflux, it is important for them to see their physician evaluate. Patients who have significant risk factors for heart disease will likely refer to see a cardiologist first to rule out a cardiac etiology of the pain. If the pain is not due to the heart, then a gastroenterology evaluation can happen. A saying among some physicians is that heartburn is not life-threatening, but a heart attack is. Be sure to see your physician if you are having symptoms.