Heartburn or chest pain: When is it heart attack?

Heartburn and chest pain are very different but can feel very much the same. Learn the difference and when to seek medical help. By Mayo Clinic Staff

You've just eaten a big meal and feel a burning sensation in your chest. Heartburn, right? Probably, but there's a chance the chest pain is a warning sign of a heart attack.

Learning to tell the difference between heartburn and something more serious may be a matter of life and death. Here's what you need to know.

What is heartburn?

Heartburn isn't a disease. It's a symptom. Characteristics of heartburn include:

  • It usually occurs after eating or while lying down or bending.
  • It can be brief or continue for a few hours.
  • You notice a burning sensation in your chest that may start in your upper abdomen and radiate all the way to your neck.
  • Stomach acid that moves up into the esophagus may leave a sour taste in your mouth — especially when you're lying down.

Normally, digestive acid in your stomach is kept from moving up into your esophagus by the lower esophageal sphincter. This ring of muscle functions as a valve, which opens only as you swallow. But sometimes the valve relaxes or weakens, allowing stomach acid to flow up (reflux) into your esophagus.

Pressure on the sphincter muscle from excess weight, overeating or lying down too soon after a meal may cause it to open slightly. Certain foods, as well as too much alcohol or caffeine, can relax the sphincter or increase production of stomach acid.

Frequent, persistent heartburn may indicate a more serious condition called acid reflux or gastroesophageal reflux disease (GERD) — the chronic regurgitation of acid from your stomach into your lower esophagus. Long-term GERD can lead to Barrett's esophagus. This is a condition in which the color and composition of the cells lining the lower esophagus change because of repeated exposure to stomach acid. Barrett's esophagus is a risk factor for esophageal cancer.

Heartburn can also be caused by an inflamed stomach lining (gastritis), a peptic ulcer or a hiatal hernia, when part of the stomach pushes up through the diaphragm and into the chest.

Can other digestive symptoms cause chest pain?

Heartburn isn't the only digestive symptom that can include chest pain. A muscle spasm in your esophagus may have the same effect. The pain of a gallbladder attack also can spread to your chest. You may notice nausea and an intense, steady ache in the upper middle or upper right abdomen — especially after a fatty meal. The pain may shift to your shoulders, neck or arms.

Apr. 30, 2011 See more In-depth