From Our 2009 Archives

Telling Heartburn From Heart Attack Can Be Tricky

By Kathleen Doheny
HealthDay Reporter

TUESDAY, May 5 (HealthDay News) -- It begins as a sharp, burning sensation in the chest, near the breastbone or ribs. But is the pain heartburn, or might it be a heart attack?

"It's often difficult for people to tell the difference,'' said Dr. Ravi Dave, a cardiologist and associate clinical professor of medicine at the David Geffen School of Medicine at the University of California, Los Angeles.

Complicating the issue is that some people with diagnosed heart disease will also have heartburn, Dave said. "Those are the patients who don't want to say, 'Oh, this is just heartburn' and not worry about it," he said.

Dr. Ronnie Fass, a gastroenterologist and professor of medicine at the University of Arizona, agreed. If you have any heart history, he said, a cardiologist should be consulted.

But even people without known heart disease who have heartburn shouldn't always just pop an over-the-counter antacid either, the doctors said. Overreacting in seeking medical help, they said, is always better than underreacting.

In garden-variety heartburn, stomach acid moves up into the esophagus and causes irritation. It might require a doctor's intervention, though, to rule out that what a person is feeling stems from heartburn and not heart problems, which can have similar symptoms.

So what's a person to do?

Pay attention to the pattern of heartburn. If people have heartburn on a regular basis after eating specific foods -- every time they dig into a greasy pepperoni pizza or drink a large glass of orange juice, for instance -- the food is generally the origin, Dave said.

They should worry, however, if they start having heartburn and have not eaten any of the food or drinks that previously triggered a heartburn episode. That would merit a call for medical help, he said.

Pay attention to when the heartburn occurs. "Patients usually get it 30 to 45 minutes after a meal," Fass said.

If the heartburn follows consumption of a specific food, it's probably run-of-the-mill heartburn, he said. But even this could become severe and need prompt medical attention.

"If you have heartburn, and it's associated with symptoms such as pain during swallowing, difficulty swallowing, loss of appetite or throwing up blood, then you have to see a doctor right away, within the next 24 to 48 hours," Fass said.

Those symptoms might indicate damage to the esophagus, or even cancer, Fass said.

See a doctor if heartburn is severe and begins to affect quality of life. A medical visit in such an instance, though, would not be as urgently needed as it would be for those with pain and swallowing problems along with heartburn.

If heartburn is a new experience, have it checked out. "That needs to be evaluated pretty quickly," Dave said, because it could point to a heart problem.

People with first-time heartburn and risk factors for heart disease -- including high blood pressure, high cholesterol, diabetes, a family history of heart problems and active cigarette smoking -- also should seek prompt medical help, Dave said.

Other reasons to talk to a doctor or go to the emergency room?

  • If heartburn accompanies exercise or other exertion. "That is a huge red flag," Dave said.
  • If a severe episode of heartburn does not get better despite such remedies as antacids.
  • If heartburn comes with other symptoms, such as shortness of breath or arm pain.

Heartburn during pregnancy, on the other hand, is usually not cause for concern, Dave said, because most often it is not heart-related.

Garden-variety heartburn should subside fairly quickly, Dave and Fass said. An episode might last up to a few hours, Fass said, and then disappear in varying lengths of time, depending on the type of remedy used to combat it.

"If you take an antacid, their effect is usually immediate," Fass said. "If you take an H-2 blocker [such as Zantac or Tagamet], it may be 30 minutes."

SOURCES: Ravi Dave, M.D., cardiologist, Santa Monica-UCLA Medical Center and Orthopaedic Hospital, Santa Monica, Calif., and associate clinical professor of medicine, David Geffen School of Medicine, University of California, Los Angeles; Ronnie Fass, M.D., gastroenterologist, professor of medicine, University of Arizona, chief of gastroenterology, Southern Arizona VA Health Care System, Tucson

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