Heartburn or heart attack? How to tell the difference

by Kaiser Permanente |
Smiling couple eating from a food truck

Chest pain can be scary. And it’s not always easy to tell the difference between heartburn and a heart attack — especially since heartburn-like symptoms can be from a heart attack. Columbus Batiste, MD, an interventional cardiologist and chief of cardiology at Kaiser Permanente’s Riverside and Moreno Valley Medical Centers in Southern California, breaks down the symptoms and details the importance of knowing if you’re at risk for heart disease.

What is heartburn?

Heartburn is discomfort or pain that occurs when food and stomach acid back up into the esophagus — the tube that leads from the throat to the stomach.

Common indicators of heartburn include:

  • A burning sensation in the chest or stomach
  • Foul breath and a sour, acidic, or metallic taste in the mouth
  • Increased gas or belching
  • Coughing, especially when lying down
  • Symptoms start after eating or lying down

You should be able to relieve your symptoms by taking an antacid or by drinking a glass of water with a spoonful of baking soda stirred in it. If heartburn is keeping you from sleeping, propping yourself up in bed can help.

Contact your doctor for advice if an antacid doesn’t temporarily ease your symptoms, this is the first time you’ve had heartburn, or your symptoms have changed.

Heart attack signs can vary greatly

Some studies suggest that men are more likely than women to experience commonly known warning signs of a heart attack — like what you’ve seen in movies and TV shows. A heart attack can occur anytime — randomly or after physical or emotional stress — and last for several minutes or longer. Chest discomfort that resolves in seconds is almost never from a heart attack.

Typical signs include:

  • Pain, tightness, or pressure in the chest
  • Discomfort traveling to the arm, neck, or jaw
  • Shortness of breath
  • Sweating

Women can experience these warning signs and shouldn’t ignore them. But for women, "absolutely nothing is typical in terms of heart attack symptoms," Dr. Batiste says. They may have a general unwell feeling or a few milder symptoms, including:

  • Nausea
  • Shortness of breath
  • Fatigue
  • Back discomfort
  • Lightheadedness

It’s vital for men and women to be familiar with the warning signs of a heart attack. If you reasonably believe you’re having an emergency medical condition, call 911 or go to the nearest emergency department.

"Silent" heart attacks are common

Nearly half of all heart attacks appear to have no symptoms* — and these so-called silent heart attacks can be just as serious, says Dr. Batiste. If you have ongoing heartburn with other persistent symptoms like fatigue and shortness of breath — and are at risk for heart disease — you should seek immediate medical attention.

Another cause of chest pain

Angina is pressure in the mid-chest — similar to indigestion pain — that occurs when blood flow to the heart decreases, sometimes due to stress. It lasts between 2 and 20 minutes and usually stops if you rest or end the stressful activity. If you’re experiencing these types of symptoms for the first time, seek immediate medical attention.

Risk factors for heart disease

Heartburn or heartburn-like symptoms could be serious if you’re prone to heart disease. Risk factors include:

  • High blood pressure
  • High cholesterol
  • Diabetes or prediabetes
  • Smoking
  • A family history of premature coronary artery disease

If you’re suffering from persistent heartburn and have one or more of these risk factors, seek appropriate medical attention right away.

Learn more about cardiac care at Kaiser Permanente.

Zhu-Ming Zhang, MD, et al., "Race and Sex Differences in the Incidence and Prognostic Significance of Silent Myocardial Infarction in the Atherosclerosis Risk in Communities (ARIC) Study," Circulation, May 16, 2016.