Cardiologist Questions Heartburn

Is there any difference between heartburn and chest pain?

My mother who is 65 years old has been complaining of pain around her chest region. She looks extremely tired and uncomfortable. She has been complaining after a short vacation where she was exposed to outside food. Could this just be heartburn resulting from indigestion or an issue of the heart? How can you tell the difference between heartburn and chest pain?

6 Answers

Heartburn (acid reflux) and angina from the heart can feel quite similar. The best clue is when it occurs: if it happens when lying down at night and is relieved by antacids, it is probably heartburn; if it's caused by walking uphill and is relieved by stopping, it's probably angina.
Heartburn and chest pain can have identical symptoms. If patient is diabetic, has kidney disease, high blood pressure or other risk factors, I would first rule out with a stress test if this is cardiac. If patient is younger than 30 years old with no risk factors, I would first treat with PPI. Exertional chest pain is more cardiac and a pain that occurs at night time when you are laying flat is more consistent with acid reflux.
It can be very difficult to sort out since cardiac symptoms in women may present differently then the classical symptoms described in men. An excellent experienced cardiologist I knew walked through his own heart attack because he thought it was heartburn!

Getting a stress evaluation may be very useful here, with the precise type being deferred to her own physician who knows her well. A medication trial may also be helpful, but less discriminatory since some cardiac and gastrointestinal symptoms are equally relieved by the same medication.

Irv Loh, MD
It can be difficult to tell the difference between heart related chest pain and indigestion. Sometimes even well trained heart specialists can be fooled. There are no simple answers to this question. She should be evaluated by her doctor ASAP and don't take any chances.
That is an excellent question. “Heart burn“ mostly occurs after meals and can be relived with antacids, but I would never think with her age and other risk factors that she may have, that it’s solely heartburn. I strongly recommend an ekg, routine labs, echocardiogram, and a stress test. Also important are the questions is the pain with activity? Relieved with rest? Quality, duration, location, duration, frequency, what makes it better or worse, after that point a good cardiologist can use that info to better focus.
Usually patients know what heartburn feels like, or have had it before. It is sometimes relieved by Tums or mylanta or other antacids. If she has risk factors for heart disease like high cholesterol, diabetes, prior smoking, sedentary life style, high blood pressure, family history of heart disease, gout etc, she is better seeing a doctor.