Heartburn is a burning chest pain or discomfort that is a characteristic feature of acid reflux – when stomach acid rises up into the esophagus (food pipe). The pain may be similar to that of a heart attack. It is not uncommon for patients with acid reflux or indigestion to present in an emergency room with the belief that they are experiencing a heart attack. However, acid reflux and a heart attack are two very different conditions with a few similar symptoms like a burning chest pain. It is important to understand the difference between these conditions and recognize the other symptoms that are more likely to be an indication of acid reflux or a cardiac event. Sweating is one such symptom. While profuse sweating for no apparent reason commonly occurs with a heart attack there are some instances when it can arise with a burning chest pain that is unrelated to a heart attack.

Why does sweating occur in certain diseases?

Sweating (perspiration) is the body’s cooling mechanism. When the temperature is rising, the blood vessels in the skin dilate allowing more blood to flow through it. This allows for heat to dissipate out of the blood and into the environment and the heat loss is further aided by sweating. When sweat evaporates from the skin, it has a greater cooling effect. This is a normal process in thermoregulation – the regulatory mechanism which allows the body to maintain the temperature within a normal range. The body temperature is constantly monitored by the thermoregulatory center in the brain.

Normally, the degree of sweating is controlled by the autonomic nervous system which is stimulated or inhibited by the thermoregulatory center in the brain. There are two divisions of the autonomic nervous system – the sympathetic and parasympathetic systems. When the sympathetic nervous system is triggered it can increase sweating. Diaphoresis is sweating, usually profuse, that arises with certain diseases and emergency medical emergencies. It may be due to some factor altering the thermoregulatory center in the brain or triggering the sympathetic nervous system.

Apart from raised body temperature due to environmental factors, there are various other causes of excessive sweating. In terms of a heart attack, the heart’s decreased ability to pump out blood activates the sympathetic nervous system in an attempt to increase heart activity. Sweating also arises as a result of this increased sympathetic activity.

Dangers of Heartburn and Sweating

There are several causes of a burning chest pain (heartburn) with sweating. A heart attack is the most serious cause and therefore it needs to be the first consideration in a person at risk. Ideally medical investigations such as an ECG (electrocardiogram) should be conducted. However, the presence of other symptoms and a person’s risk probability of coronary heart disease can be deciding factors to the likelihood of a heart attack being the cause of heartburn and sweating.

Other Symptoms

The presence of one or more of these symptoms may mean that heartburn and sweating is more likely to be due to a heart attack.

  • Difficulty breathing
  • Dizziness
  • Fainting
  • Anxiety
  • Crushing pain in the chest also described as pressure, fullness or squeezing.
  • Pain that worsens over minutes.
  • Pain radiating to the arm, neck and jaw especially on the left side.
  • Paleness.
  • Cold clammy skin.
  • Nausea and/or vomiting.

It is also advisable to consider various other characteristics of cardiac and non-cardiac chest pain.

Risk Factors

Heartburn and sweating should always be excluded as signs of a heart attack in a person with one or more of the risk factors of coronary heart disease, even if other symptoms are not present.

  • Age 0ver 45 years.
  • Obesity.
  • Sedentary lifestyle.
  • Psychological stress.
  • Cigarette smoking.
  • Hypertension (high blood pressure).
  • Hyperlipidemia (high blood fats).
  • Diabetes mellitus.
  • Family history of heart disease.

Causes of Heartburn and Sweating

  • Gastroesophageal reflux disease (GERD) is the backward flow of stomach acid into the esophagus (food pipe). It tends to worsen after eating, when lying flat or during sleep. Sweating is unlikely to be seen along with heartburn in GERD but can occur in rare instances. GERD occurs in a person with a weakened lower esophageal sphincter (LES) and can be triggered with the use of alcohol, caffeine or overeating.
  • Heart attack (myocardial infarction) is death of a portion of the heart muscle most commonly due to an obstruction of one or more of the coronary arteries. The risk factors have been discussed above and it can strike at any time in a person with coronary artery disease. It is more likely to occur during episodes of strenuous activity or intense emotional stress.
  • Angina pectoris is chest pain that arises in a person with coronary heart disease especially during periods of physical activity or psychological stress.  The narrowed coronary arteries may still allow sufficient blood to reach the heart in most situations but at times when the heart requires more blood, like when it is working harder, the blood supply is insufficient. This leads to pain. Sweating is not as common a symptom in angina pectoris as it is in a heart attack.
  • Anxiety is a feeling of agitation and nervousness that may arise with certain situations. It is a normal emotion but can sometimes persist for no known reason in which case it is referred to as a generalized anxiety disorder. Certain conditions or hormone fluctuations may present with anxiety and this include premenstrual syndrome (PMS), menopause and in depression. Chest pain is a common symptom although in most cases it cannot be attributed to any specific cause. Sympathetic activity also causes other symptoms like sweating.
  • Food allergy is an abnormal immune reaction triggered by consuming certain foods like shellfish, nuts, eggs and milk. A severe type of allergic reaction known as anaphylaxis causes symptoms such as difficulty breathing, dizziness, rapid heart rate, chest pain and sweating. Anaphylaxis can be life threatening if left untreated.
  • Carcinoid syndrome is a condition where a certain type of cancer (carcinoid tumor) produces and secretes certain chemicals into the bloodstream. Difficulty breathing, chest pain and profuse sweating, particularly night sweats, are some of the symptoms of carcinoid syndrome.

Article reviewed by Dr. Greg. Last updated on August 3, 2013