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Is it heartburn or a heart attack?
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By Natasha Persaud
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January 2009
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Chest discomfort or pain can indicate any number of medical conditions, some more serious than others. Here, Prediman K. Shah, M.D., director of the Division of Cardiology and the Atherosclerosis Research Center at Cedars-Sinai Medical Center in Los Angeles, describes some of the possible causes.
A wide range of conditions may cause chest discomfort, including pneumonia, digestive problems, angina, sore muscles, inflammation, a fracture, even anxiety.
The most potentially dangerous causes of chest pain include heart attack, aneurysm of the aorta, a blood clot in a lung, air in the sac surrounding the lungs or inflammation of the covering of the heart or lungs. Adults older than 60, patients with an existing heart or lung condition or injury and those with autoimmune disorders are among those more likely to be at risk for these conditions.
Yes. Some people experiencing heart attack feel discomfort similar to heartburn; the reverse is also true.
If you frequently experience heartburn, and your current symptoms are exactly the same--and nothing different has occurred--then it’s more likely that you have heartburn.
If your symptoms are out of the blue, however, it may possibly indicate a heart attack. You should be especially suspicious if the pressure or pain you experience is accompanied by nausea, weakness or shortness of breath.
You should also suspect it might be heart attack if you have any of the risk factors listed in the box below. For many people, the first symptom of heart disease is a heart attack.
Angina and heart attack are on the same continuum. Both interrupt blood flow to the heart but to varying degrees: angina results from partial blockage of a coronary artery from plaque; a heart attack results from a complete or almost complete blockage from plaque and/or a blood clot.
Both may produce feelings of discomfort, pressure or pain. The difference may be duration. In angina, the pressure or pain typically lasts 5 to 10 minutes, and stops when activity is stopped (or, if you’re being treated for angina, when you take a nitroglycerin pill). Heart attack pain typically lasts for 15 or 20 minutes and may come on suddenly, even without exertion.
People with abnormal cholesterol levels or plaque buildup (atherosclerosis), are at risk for both angina and heart attack.
No. In fact, some heart attack patients do not experience chest discomfort or pain at all. Heart attacks can start slowly, as a mild pain or discomfort or even as fatigue or a general feeling of being unwell. Your symptoms may even come and go.
Women, for example, are more likely to report pain in the middle or upper back, neck or jaw; shortness of breath; nausea or vomiting; indigestion; loss of appetite; weakness or fatigue; cough; dizziness; and palpitations.
If someone has symptoms that could be a heart attack, the safest thing to do is to call 911 for an ambulance. Don’t drive yourself to the hospital or ask someone else to take you. The risk for life-threatening heart beat irregularity is highest in the first hour of a heart attack. In an ambulance, you can receive prompt medical attention and at the hospital, you can receive clot-busting drugs or other artery-opening treatments.
Heart disease is the leading cause of death for men and women in the United States. To reduce your chances of developing the disease, adopt a healthy lifestyle:
• Exercise at least 30 minutes daily—more is better.
• Eat a heart-healthy diet filled with fruits and vegetables, beans, legumes, whole grains and fish.
• Eat less red meat and full-fat dairy products (e.g., whole milk, cheese, butter, cream, etc.). Also curb other foods that contain saturated fat and trans fat.
• Quit smoking.
• Have regular medical check-ups to evaluate your blood pressure, blood sugar and cholesterol levels (at least once a year, if you are healthy; more often if one or more levels is elevated). Your doctor may also suggest additional tests depending on your risk factors.
I follow the guidelines adopted by the Society for Heart Attack Prevention and Eradication (SHAPE), which call for non-invasive imaging tests, in addition to the tests above, to identify plaque buildup in the arteries. The reason: More than half of heart attack victims have normal cholesterol levels, and probably didn’t realize they were at risk.
Even if you are relatively healthy, ask your doctor if you might benefit from having one of these imaging tests to detect arterial disease. The screening—either a coronary calcium scan or a carotid scan, or both—is appropriate for men 45 and older and women 55 and older. Each screening costs about $200 to $400; the tests are typically not covered by insurance.
Why have the screening? The testing identifies additional patients who may be at risk for heart disease, allowing them the opportunity to receive lifesaving treatment earlier.
Women who have gone through early menopause, either naturally or because they have had their ovaries removed, are twice as likely to develop heart disease as women of the same age who have not yet gone through menopause. Also: women on oral contraceptives have a higher risk of blood clots. According to preliminary research, women older than 63 taking hormone therapy may have a higher risk of cardiovascular disease.
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The following is a list of heart attack signs from the National Heart, Lung and Blood Institute:
• Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts for more than a few minutes, or goes away and comes back. The discomfort can feel like uncomfortable pressure, squeezing, fullness, or pain.
• Discomfort in other areas of the upper body. Can include pain or discomfort in one or both arms, the back, neck, jaw, or stomach.
• Shortness of breath. Often comes along with chest discomfort. But it also can occur before chest discomfort.
• Other symptoms. May include breaking out in a cold sweat, nausea, or light-headedness.
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 | Prediman K. Shah, M.D., is director of the Division of Cardiology and the
Atherosclerosis Research Center at Cedars-Sinai Medical Center in Los
Angeles.
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