Heartburn or heart attack? Health First cardiologist says subtle signs can hide a medical emergency

ROCKLEDGE — A burning feeling in the chest can seem like nothing more than heartburn, especially after a meal or if it wakes you in the middle of the night. Many people reach for an antacid and move on.

But that same discomfort can also signal a heart attack, according to Dr. Sara Khodor, an interventional cardiologist with Health First.

Khodor said the two conditions can be difficult to tell apart. “Heartburn and heart attack symptoms can be very similar and sometimes indistinguishable,” she said.

Heartburn usually comes from stomach acid irritating the esophagus, while a heart attack happens when blood flow to part of the heart muscle is blocked, which can cause lasting damage.

That overlap makes the symptoms tricky, because both can affect the same general part of the body. Heartburn may cause a burning sensation in the upper abdomen or center of the chest, sometimes with a sour or bitter taste, especially after eating or when lying down.

Heart attack symptoms, however, are not always the dramatic chest-crushing pain often shown in movies. “The textbook description is a pressure or a heaviness sensation,” Khodor said, comparing it to the feeling of an elephant sitting on the chest.

In real patients, she said, the symptoms can vary widely. People may describe tightness, burning, squeezing or heaviness. Pain can also spread to the jaw, shoulders, arms or back, and some patients feel it in the upper abdomen instead of the chest.

One warning sign is discomfort that shows up with physical activity. “Anything with exertion, I would be concerned about cardiac disease,” Khodor said. She added that even if antacids help, that does not rule out a heart attack or heart disease. “Relief of symptoms with antacid should not exclude a heart attack or heart disease,” she said.

Identifying a heart attack can be especially difficult for women. Although women can have the classic chest pain, Khodor said older adults and people with diabetes may also have less obvious symptoms. Women may experience chest discomfort, but they can also have unusual fatigue, shortness of breath, nausea, vomiting, sweating, dizziness or lightheadedness.

“I’ve had patients who come in saying they’re just really fatigued with exertion that’s not usual for them and not necessarily pain in the chest,” she said.

Shortness of breath during activity can also point to a heart issue even when chest pain is absent. Because these symptoms can resemble other conditions, Khodor said it is important to look at the full clinical picture rather than focus on only one sign.

Heart attacks are not limited to older adults or people with obvious risk factors. Khodor said she has treated patients as young as 30 and is seeing more younger adults with significant coronary artery disease.

“I’ve had plenty of patients in their 40s and I consider that very young,” she said.

Even people who exercise, stay at a healthy weight and eat well are not necessarily protected. Khodor recalled treating active patients who played pickleball regularly, developed symptoms during exercise and later learned they had severe coronary blockages. Some needed stents, while others required coronary bypass surgery.

Family history, smoking, diabetes and other health problems can raise cardiovascular risk, but not having those factors does not guarantee safety.

When chest discomfort is new, persistent or worrying, or when other heart attack symptoms appear, Khodor recommends emergency evaluation instead of waiting to see if the problem goes away.

“If someone is experiencing persistent chest pain, they should seek emergency care so treatment can be escalated quickly,” she said. Anyone with possible heart attack symptoms should call 911 rather than drive themselves to the hospital.

She also urges patients to be honest about their medical history, habits and symptoms, even if they feel embarrassed. That information helps doctors judge cardiovascular risk and decide which tests or treatments are needed.

“We’re not here to judge anybody’s background, social history, medical history or their risk factors,” she said.

Khodor’s advice is simple: do not try to diagnose dangerous chest discomfort at home. For more information about heart health, available services, or to find a heart care provider, visit hf.org/heart.