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Can You Tell If It's a Heart Attack--or Just Heartburn?

Distinguishing between them is nearly impossible. That's why you need to seek medical care.

Every year, 8 million people present to the emergency department (ED) with chest pain (angina), a common symptom of heart attack. But more than half are diagnosed with heartburn or other gastrointestinal issue and sent home.

Could you have told the difference between heartburn and heart attack? Probably not.

"Even for a well-trained physician, it's very difficult to differentiate between these two entities. Certain distinguishing characteristics may help, but there's no way to be absolutely sure without expert help," says Cleveland Clinic cardiologist Michael Rocco, MD.

Similarities and Differences

Heartburn is a symptom of gastroesophageal reflux disease (GERD), often called acid reflux. Acid from the stomach bubbles up into the esophagus, causing a painful burning sensation or pain in the center of the chest.

While a heart attack can produce the same symptoms, there are minor differences.

"The devil is in the details: certain characteristics of the symptoms, the presence or absence of accompanying symptoms and what triggers symptoms," says Dr. Rocco.

These differentiating factors include:

> Type or quality of symptoms: Heartburn is often a true burning sensation that may start in the abdomen and radiate to the back of the throat. Sometimes it presents as a I sharp pain. Classic angina is typically characterized by a sense of pressure, squeezing or tightness in the chest that may radiate to the arm or jaw. Overlap: A heart attack occurring on the back of the heart may produce symptoms just below the ribs and be mistaken for heartburn.

> Accompanying symptoms: Heartburn may produce a sour taste in the back of the throat. Typical symptoms of heart attack that are less common with heartburn include shortness of breath, sweating, dizziness and unexplained fatigue. A heart attack also may cause unusual sensations or an unexplainable feeling of dread. Overlap: Both conditions may cause nausea.

> Triggers: Heartburn is more common after eating (especially acidic foods), or when lying down or bending over. Angina is more likely to be provoked by sudden exertion or intense emotional stress.

> Duration of symptoms: Heartburn may resolve with antacids or a change in position, such as sitting up or standing. Angina is unlikely to improve with these measures.

> The role of personal history: If you have had reflux with similar symptoms and were diagnosed with GERD, you may be experiencing a recurrence. If you have diabetes, heart disease or multiple cardiovascular risk factors, the sudden onset of new chest pain should prompt you to seek medical attention.

Other Causes Confound

Acute heart attack--a heart attack happening right now--is the biggest concern when chest pain occurs. But the symptoms of angina are an indication of underlying coronary artery disease and increased risk of heart attack. That's why it's important to have such symptoms evaluated.

Additionally, reflux isn't the only gastrointestinal problem that can cause chest pain. Esophageal spasm, acute pancreatitis and gallbladder disease can produce similar symptoms.

"Getting a proper diagnosis is important, whether symptoms are from the heart or gastrointestinal tract. In both cases appropriate management can help prevent complications," says Dr. Rocco.

The Bottom Line

Because it's so difficult to be sure which issue is causing your symptoms, go to the ED for an evaluation. At minimum, call your doctor--even in the middle of the night. "If it turns out to be a gastrointestinal problem, it likely won't kill you, but a heart attack might," says Dr. Rocco.

As a precaution, chew a full-strength aspirin while you are waiting for the ambulance. "If you have a history of ulcers, a single aspirin is unlikely to cause problems," he says.

Don't be embarrassed if you go to the ER only to learn your condition is not life threatening.

"Once a heart attack has been ruled out, you can move forward to determining what caused your symptoms and what needs to be done next," says Dr. Rocco.

Caption: Symptoms of heart attack can mimic those of reflux. Learn the differences, but don't take chances: Better to be safe than sorry.
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Title Annotation:AWARENESS
Publication:Heart Advisor
Date:Feb 22, 2019
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