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 overeating, excess weight 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.
Persistent or frequent heartburn may indicate a more serious condition called acid reflux or gastro esophageal reflux disease (GERD) — the chronic regurgitation of acid from your stomach into your lower esophagus.
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.
Uncomfortable feelings in your chest can be scary. It can be confusing as to whether they are caused by a heart attack or simply acid reflux. While it could be heartburn caused by GERD, it could also be a potentially fatal heart attack. So how can you tell the difference?
Symptoms of GERD
- 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.
Symptoms of a Heart Attack
- Sudden pressure, tightening, squeezing or crushing pain in the center of the chest that lasts more than a few minutes.
- Mild chest or upper body pain or discomfort — most heart attack symptoms start slowly.
- Pain or discomfort spreading to the back, neck, jaw, stomach, shoulders or arms — especially the left arm.
- Shortness of breath with or without chest discomfort.
- Chest discomfort accompanied by sweating, lightheadedness, dizziness or nausea.
- Pressure or tightness in the chest during physical activity or when you’re under emotional stress.
5 Questions to Ask Yourself
1. What type of pain is it?
GERD-related heartburn involves a burning sensation right below your breastbone or ribs. That burning feeling could move up toward your throat, as the acid surges up. The pain will increase if you bend over or lie down, or if you try to lift something heavy.
A heart attack, on the other hand, will involve a dull pressure or pain in the center of your chest that comes on suddenly and severely. Feelings of fullness or tightness also could occur, as though your chest is being squeezed. The pain might spread to your neck, arms, or shoulders, something that rarely occurs with heartburn.
2. What other symptoms am I having?
GERD-related heartburn often will cause a sour taste in the back of your mouth from acid reflux.
Heart attacks often produce cold sweats, a symptom not common in heartburn, as well as lightheadedness, nausea, shortness of breath, and heart palpitations.
3. What was I doing when the pain started?
GERD-related heartburn usually occurs about 30 to 45 minutes after you’ve eaten a big meal, especially if you lie down immediately afterward. It also might happen if you’ve eaten fatty or greasy foods, acidic foods, spicy foods, or foods containing caffeine.
Heart attacks often occur after physical exertion that spikes your blood pressure. They also are more likely to occur during times of high stress — for example, most heart attacks occur in December and January, around the holidays.
4. What makes the pain go away?
GERD-related heartburn will respond to antacids.
Heart attack pain will respond to nitroglycerin tablets.
5. How long has the pain lasted?
GERD-related heartburn pain typically will diminish after 5-10 minutes.
Heart attack pain is longer-lasting, and may fade away and come back.
If you are questioning whether or not you are having a heart attack, seek medical care immediately. It’s best to rule out GERD than to take a chance that you could be avoiding help for a heart attack. Prompt care can save your life. And even if it ends up being just GERD, the doctor can prescribe medications to ease your symptoms.