Heart to Heart: Determining Whether You Need an ER or an Antacid

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In this “House Call,” Dr. Zachary Levine helps you decipher whether it’s a heart attack or heartburn.

A heart attack occurs when a coronary artery is blocked, leading to lack of oxygen and nutrients to the heart. It is a life-threatening emergency, and most people know to go to emergency when they have symptoms consistent with a heart attack: chest heaviness or pressure that may radiate into the jaw or arm, shortness of breath, dizziness, sweating and palpitations. For women, symptoms may not include chest pressure; some experience shortness of breath or nausea or back pain. Of course, many people who present with heart attack symptoms end up having a benign cause like heartburn.

So how do doctors know whether it’s a heart attack or heartburn? The symptoms, what brings them on and what relieves them are your clues.

The symptoms

Heartburn is usually a burning sensation not associated with shortness of breath or dizziness but with reflux of stomach acid into the esophagus and has nothing to do with the heart. The burning behind the breastbone (sternum) can radiate all the way up to the throat and tends to be worse lying down, bending over and after eating. People may also get an acid taste in their mouth.

Heart attack pain, in comparison, is typically felt more as a pressure and is associated with shortness of breath and dizziness. If you know you have heartburn or heart disease and have experienced the symptoms before, then that can guide you as well.

The cause

Large meals and fatty foods increase the chances of heartburn along with certain foods that relax the gastroesophageal sphincter (the valve between the stomach and esophagus), which can lead to heartburn. These foods include alcohol (particularly red wine), black pepper, garlic, raw onions, spicy foods, citrus fruits and products, chocolate, coffee and caffeinated drinks, including tea and soda, peppermint, and tomatoes.

The relief

Heartburn pain tends to be helped by antacid medication. Pain from heart attack (and angina) improves with rest and medications such as nitroglycerine.

A number of other conditions can mimic heart attack symptoms, such as panic attacks, blood clots in the lungs and even pneumonia. When there is any doubt, err on the side of caution and get it checked out.

A version of this article appeared in the June 2019 issue with the headline, “Heart to Heart” p. 22.