Is It Heartburn or a Heart Attack? How to Tell

man with chest pain

Is that burning sensation in your chest simply heartburn or the sign of something much worse? It’s not always easy to tell.

Unfortunately, the stakes couldn’t be higher. Forty percent of women and 30 percent of men with coronary artery disease experience this symptom, cardiologist Barbara Williams, MD says.

Signs of Heartburn

In general, heartburn usually feels like an ache just under the tip of the breastbone, indigestion or indigestion with nausea, Dr. Williams says. Coronary artery disease involves symptoms radiating throughout the upper torso, from the lower jaw to the waistline, and including the neck, upper back, both arms and stomach area.

“Discomfort is often described as an ache, tightness or indigestion,” she says. “And indigestion is often unrelated to eating.”

The timing of symptoms may give you a clue that indigestion is the problem, says bariatric surgeon Leena Khaitan, MD. Symptoms may occur after a heavy meal or after consuming chocolate, peppermint or caffeine.

Heartburn will usually respond to an antacid (a substance that neutralizes stomach acidity), she says, while heart symptoms will not. But, she cautions, “people should not try to make that distinction themselves and instead seek a professional medical opinion.”

When Heartburn Might Be Serious

If the symptoms of indigestion last more than five minutes or are intermittent – and especially if the indigestion is associated with nausea or vomiting or heavy sweating – Dr. Williams advises to go straight to the ER.

“Unfortunately for women, many never experience warning symptoms before their first heart attack,” she says. “Their first symptom – indigestion – is their heart attack. On average women wait 2½ hours before seeking medical help. A lot of muscle can die in that time.”

Women and men also should understand their risks for developing coronary artery disease: age, high blood pressure, and elevated blood sugar and cholesterol levels. Although smoking increases the risk of heart disease for both genders, women who light up are more likely to suffer a heart attack than men who smoke, Dr. Williams says.


If heart problems are ruled out, it’s still important to get to the bottom of your symptoms, Dr. Khaitan says. Heartburn is a symptom of gastroesophageal reflux disease, or GERD. The condition can cause difficult or painful swallowing, hoarseness and even frequent ear infections. Additionally, GERD can cause ulcers to develop in the esophagus.

Because GERD can cause such complications, it’s wise to see a specialist if symptoms persist, Dr. Khaitan says.

“You may require long-term medications and we are now learning that long-term use may cause complications,” Dr. Khaitan says. “But we also have a lot of other options for treating reflux such as surgical and endoscopic procedures.”

Barbara Williams, MD, is a cardiac disease specialist with University Hospitals Harrington Heart & Vascular Institute.

Leena Khaitan, MD, is Director of the Esophageal & Swallowing Center and the bariatric surgery program at UH Cleveland Medical Center and UH Geauga Medical Center.

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