Heart Attack Or Indigestion?


You’re at a party, sipping a beer, when suddenly you experience chest pain. You look around, embarrassed, wondering if you should go to the ER or hide in the bathroom.

Is it a heart attack or too much hot sauce?

Chest pain experienced as a result of an acid reflux problem can feel exactly like that of a heart attack. The pain is often mid-chest, though can be off to the left. It can hurt through to the back, or radiate into the abdomen, jaw, or arm. Moving around seems to make no difference. Sweating and/or belching and nausea may occur.

If both conditions feel the same, how can you tell the difference?

This is how a doctor would approach the problem. First, if you’re at high risk for heart disease, a physician would assume it is angina or a heart attack until proven otherwise. If you already have heart disease and/or diabetes, have high cholesterol, if you smoke, are overweight, are over 45 years old, and have no history of a stomach acid problems, call 911. You don’t want to fall over dead if you’re wrong.

While you wait, ask someone for an antacid, preferably liquid, but chewable will do. Take a double dose and see if your symptoms resolve or lessen. Antacids neutralize acid on contact, and often relieve symptoms in minutes. Other medicines that lower acid production (Pepcid, Zantac, Tagamet, Axid, Prilosec, Prevacid, Nexium, Aciphex, Protonix, and Dexilant) take longer to work – easily 30 to 60 minutes, and will not relieve your symptoms before the paramedics arrive. If you’re fine by the time they get there, they’ll still do an EKG and assess the situation.

Sometimes a heart problem will show up on an EKG, sometimes it won’t. If there’s any doubt, you should be taken to a hospital where blood tests can help determine if heart damage has occurred. If the question is still unresolved at this point, a stress test is usually the next step. If that turns out normal, doctors usually conclude the problem is not coming from the heart and turn their attention to other causes.

Now, what if you’re young and healthy, and therefore at minimal risk for heart disease? In this case the chest pain is likely an acid indigestion problem. Again, ask a friend for an antacid and see if your symptoms resolve. If the antacids help, keep in mind that the pain is likely to return as more stomach acid is manufactured. The antacids can be repeated when needed, and taking an OTC acid-lowering medication (from the list above) may help prevent their return. Seeing your doctor is not a bad idea, to determine how to lessen the risk of repeat problems.

If the situation is not a crisis, a doctor would take a longer history. The first set of questions would be aimed at ruling out the most serious condition, i.e. – heart attack. Are you at risk? Does it run in your family? Are you overweight, a diabetic, a smoker? Have you had the problem before? Is your cholesterol high? Are you short of breath? Does the pain come on when you move around?

The next set of questions would be looking for less worrisome conditions. Does it hurt to touch? (This is very rarely heart-related.) Does the pain worsen with alcohol or certain foods? (Tomatoes, onions, spicy foods, chocolate, and coffee are common offenders.) Is the pain predictable, as in every time you go to a party? Do stomach problems run in your family? Have you been taking an anti-inflammatory drug such as aspirin or ibuprofen? Have you had the problem before? Have you taken anything for it? If so, was it effective?

Doctors look for patterns to sort out illnesses. Heart-related chest pain is often accompanied by shortness of breath and is more likely to occur with or after exercise. Acid reflux-related chest pain frequently occurs after eating irritating foods, taking medications, or drinking alcohol.

Don’t feel bad if you can’t discern a pattern – it often takes time to tell and a single incident does not establish a pattern. It’s safer to see your doctor, who may want to do an EKG or have you get an X-ray. Understanding your body is the first step to a cure or treatment.

In the meantime you may want to give up behaviors that lead to either heart-related chest pain or acid-related chest pain: stop smoking, avoid alcohol, limit potentially irritating foods, be careful about using anti-inflammatory medications. If you watch yourself closely, you may discover a pattern that you can report to your doctor, who can then use this information to help determine the proper course of action.

Copyright 2010 Cynthia J. Koelker, M.D.