Most of us think that we will be able to spot a heart attack when we see one. The typical image of a person clutching their chest, gasping for air and falling to the ground is the way we have seen heart attacks portrayed time and again in the media. Pretty easy to spot even if you have absolutely no medical training. But you may be totally off the mark. A recent study in Iceland has shown that typical heart attacks are far less common than atypical heart attacks (silent heart attack).

In fact, some of the symptoms that we think is due to a heart attack may actually have nothing to do with the heart. Everyday emergency rooms around the world are faced with patients who think that they are having a heart attack but are actually experiencing severe episodes of indigestion and heartburn, among other non-cardiac causes of chest pain. Nevertheless, there is no harm in being cautious especially if you are in a high risk category for having a heart attack.

We look at some of the ways to distinguish between a heart pain and heartburn as well as other causes of non-cardiac chest pain. However, it needs to be stressed that if you suspect that you are experiencing the symptoms of a heart attack then immediate medical attention is essential. Remember that at times even a medical professional is not able to identify heart pain for other causes of chest pain without doing further tests like an ECG (electrocardiogram). Trying to identify the cause of the pain solely by the symptoms is therefore not a reliable technique.

Difference between heart pain and heartburn

Heart Attack Pain

The two terms seem similar but are actually very different symptoms.

Heart pain is any discomfort and pain arising from the heart. Most of us only think about a heart attack, which is known as a myocardial infarction, but there are a host of other heart problems. The most painful heart conditions involve situations where there is insufficient oxygen supply to the heart causing a type of injury (ischemia) of the heart muscle (myocardium). A heart attack is the most severe consequence of this type of injury. In a heart attack, a portion of the myocardium dies due to inadequate oxygen supply for a sustained period.

There are a host of conditions that can can cause pain in the chest and it has nothing to do with the heart. One such symptom is heartburn which actually has nothing to do with the heart. It is a symptom of acid reflux (medically known as gastroesophageal reflux disease or GERD for short) where the acidic contents of the stomach flow backward up into the esophagus (foodpipe) and irritates the esophagus. It is typically a burning chest pain. Due to the closely proximity to the heart and the type of pain, it is referred to as heartburn. Here the inner lining of the esophagus is inflamed as a result of injury caused by the potent gastric acid and some stomach enzymes.

Type of pain feeling

Pain is highly subjective and descriptions can vary from person to person. However, most people describe heart attack pain and heartburn in specific ways.

  • Heart attack pain is typically dull, crushing and constricting in nature. Sometimes it may be described as a squeezing pain or heaviness. There are also instances where people feel a burning pain similar to heartburn.
  • Heartburn is as the name suggests – a burning pain in the chest. The burning sensation is a result of the stomach acid injuring the esophageal lining. However, there are instances where heartburn may feel like a heaviness, a constricting feeling in the chest or a sharp pain.

Location of the chest pain

Both heartburn and heart pain are a pain located in the chest but there may be some subtle variation in the location. Typically heart pain is felt towards the center of the chest and fans outwards.  Heartburn is also somewhat centrally located but slightly to the left side. It can extend as high up as the neck. The pain of heartburn is more localized in that a person may be able to isolate the location of the pain to one spot. Nevertheless, it is difficult to differentiate between heartburn and heart pain solely on the location.

Pain radiates away from the chest

The pain in a heart attack radiates to certain locations away from the chest in many instances. This means that a person will feel the pain in the chest extending all the way to another location. Common sites where the pain radiates to in a heart attack includes :

  • Arm, usually the left shoulder and upper arm
  • Neck
  • Jaw
  • Upper middle part of the abdomen (epigastrium)

When the pain is felt only at these sites without chest pain then it is known as referred pain. It is important to note that although the pain may be perceived at these locations, the problem lies with the heart itself.

There is usually no radiating of pain in heartburn. At most the discomfort may be felt as high as the throat or as low as the upper part of the abdomen, sometimes in the middle or on the left side, but this is uncommon. Even when present, it is the pain in the chest that is typically more severe in acid reflux.

Triggers or worsens the pain

There are various factors that can trigger or worsen the pain. Exercise and a heavy meal can actually trigger both heart pain and heartburn and worsen it. With regards to exercise, heart pain usually worsens during physical activity while heartburn more often occurs after strenuous activity. Major emotional upsets are more likely to trigger heart pain that heartburn while changes in posture, like lying down, are more likely to trigger or worsen heartburn than heart pain. In pericarditis, a condition where the lining around the heart is irritated, leaning forward or sitting up tends to relieve the heart pain.

Eases or relieves the pain

Although these are several factors that can ease or relieve heart pain or heartburn, the most conclusive means is the change in pain when using certain medication. In fact this is one of the single most important ways of differentiating between cardiac and non-cardiac chest pain before even starting diagnostic tests.

Nitroglycerin or nitrates causes the coronary arteries of the heart to become wider (vasodilation) More oxygen-rich blood can then reach the heart muscle wall. Nitroglycerin cannot ease or relieve heartburn. It is very effective in relieving angina pain and can be helpful in a heart attack although the pain may not ease.

Antacids are one of the most common drugs used to treat heartburn. It works by neutralizing the acid and some provide a short term coating of the inner esophageal wall. Antacids will not relieve heart chest pain. This important factor means that heartburn can be differentiated from heat pain by the response to antacids.

Rest has a more prominent effect on easing or relieving heart pain and has only a slight benefit in heartburn and then too only in some cases. Light physical activity like a short walk can help ease some degree of heartburn by promoting gastric emptying. Sitting upright can also ease heartburn yet it has little effect on the heart pain, except with pericarditis.


Article reviewed by Dr. Greg. Last updated on February 4, 2013