Ask the doctor: What's the best way to tell heartburn from angina or a heart attack?

Content provided by the Faculty of the Harvard Medical School

Ask the doctor: What's the best way to tell heartburn from angina or a heart attack?

Ask the doctor

What’s the best way to tell heartburn from angina or a heart attack?

Q. I’m worried that someday I will confuse my heartburn with my angina or a heart attack and end up in the emergency room for nothing. How do I tell the difference?

A. That’s an excellent question, one that is often tough for doctors to answer without some further testing. Many people mistake heartburn for angina or a heart attack. Others ignore pain from angina or a heart attack because they think it is just heartburn.

One clue comes from what you were doing before the symptoms started. Heartburn tends to occur after meals, when you have more acid in your stomach, or when you are lying down, which allows stomach acid to trickle into the esophagus. Chest pain from angina is more likely to happen when you are exerting yourself or have been outside in the cold. (This isn’t a 100% reliable rule, since angina can hit you after a meal, too.)

The sensation of pain can also help you tell them apart. Most people feel heartburn as a burning in the chest. Angina is more often a vague feeling of tightness or pressure deep within the chest. That doesn’t always work, though, since heart attack pain is often described as “burning” discomfort.

Location may be another guide. Heartburn pain is usually localized in the middle of the chest, while heart attack pain can radiate through the back and down an arm.

Response to medication is another way to tell them apart. Nitroglycerine usually eases angina, while heartburn is more likely to be relieved by antacids.

Distinguishing between angina and heartburn is important enough to warrant a discussion with your doctor to be sure you are correctly interpreting your symptoms. And if you ever have new chest pain that worries you, be safe and call 911.

— Thomas Lee, M.D. Editor in Chief, Harvard Heart Letter

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Last updated:	August 21, 2006

Medical content reviewed by the Faculty of the Harvard Medical School. Harvard Health Publications, Copyright © 2007 by President and Fellows of Harvard College. All rights reserved. Used with permission of StayWell.

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