Baylor College of Medicine

Chest pain

Heartburn or heart attack?

Molly Chiu


Houston, TX -

A big meal may cause heartburn or aggravate chronic acid reflux but sometimes the symptoms aren’t what you’d expect. How do you tell the difference between chest pain from heartburn and a heart attack? According to Baylor College of Medicine gastroenterologist Dr. Suneal Agarwal, it starts with knowing your body and your risk for both conditions.

“If there are factors that suggest you may have heart disease, such as family history, smoking, diabetes or hypertension, then you should seek care to address the heart right away,” said Agarwal, assistant professor of medicine – gastroenterology at Baylor. “Traditional heartburn is more of a burning sensation rather than a true pressure sensation, but often it is hard to tell the difference.”

Reflux happens when an abnormal amount of stomach acid enters the esophagus. Typical symptoms include heartburn (a burning feeling in the chest or throat), regurgitation (the sensation that stomach fluids are backing up into the throat) and difficulty swallowing. But some patients may present with less typical symptoms such as coughing, wheezing or chest pain that some may describe as comparable to a heart attack.

Pressure and pain due to reflex usually begin about 30-45 minutes after a meal. People with reflux disease may notice a pattern of heartburn after meals.

“If patients are having reflux episodes occurring more than 2-3 times a week, they should seek consultation with a gastroenterologist or their primary care physician,” Agarwal said.

Lifestyle changes can help address reflux disease. Agarwal recommends weight loss, avoiding meals before bed and refraining from lying down after a meal. Certain foods like citrus, chocolate, fatty foods, spicy food, alcohol, caffeine, carbonated beverages and peppermint may trigger reflux, and people can modify their diets to help improve symptoms. There also are medications like proton-pump inhibitors, histamine blockers and antacids that can decrease or neutralize stomach acid.

Seeing a doctor is important for patients whose condition does not improve with these treatments. It is important to assess any complications due to reflux and rule out other serious conditions.

“If a patient develops reflux symptoms suddenly after the age of 45 or has what we refer to as red flag symptoms (weight loss, trouble swallowing, family history of esophageal or gastric cancer), they should see a gastroenterologist,” Agarwal said.

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