Heartburn or Heart Attack? How to Tell the Difference

Chest discomfort can be equal parts frightening and confusing: Is the pressure or pain in your chest signaling a cardiac emergency — or a simple case of heartburn or indigestion?

Sometimes, an understanding of these two conditions can suggest the source of your discomfort. There are certain heartburn and heart attack symptoms that can offer clues as to what’s happening and therefore what’s the best action for you to take.

The challenge in quickly determining whether you’re having a heart attack or dealing with a case of heartburn is that the two conditions share overlapping symptoms. Even healthcare providers can’t always differentiate them based on symptoms alone.

One key difference lies in how it feels. A heart attack is often described as pressure, tightness, squeezing, or constriction in the chest, rather than sharp pain, says Nishant Shah, MD, a cardiologist at Duke Health in Durham, North Carolina. Many people don’t describe the sensation as pain at all. Instead, it may feel like heaviness or discomfort spread across a broad area of the chest, he says.

Heartburn, on the other hand, is caused by stomach acid moving upward into the esophagus. It can be triggered by certain foods and tends to feel like a burning sensation in the chest or upper abdomen that may rise toward the throat, says Shah.

But those distinctions aren’t foolproof. Heart-related symptoms don’t always feel “textbook,” and digestive symptoms don’t always present predictably. “It’s important to not just chalk up chest discomfort to heartburn, especially if you’ve never had it before," says Shah.

How long it lasts matters too. Chest pressure or discomfort that persists, worsens, or keeps returning shouldn’t be ignored, he adds.

If your symptoms are severe, persistent, not resolving, or have you worried, then seek immediate medical attention to get evaluated for a heart attack, says Shah. “If the symptoms are on and off, then it’s important to understand the pattern,” he says.

If you’re dealing with chest discomfort of an uncertain source, Shah recommends asking yourself the following questions to help determine your next steps:

• Are your symptoms only happening after you eat, or do they occur at other times as well? If they’re only linked with eating, that may mean you’re experiencing heartburn.
• Do you have a history of heartburn and know what heartburn pain feels like? If you do, and your pain feels similar, then taking an antacid to see if symptoms subside makes sense, says Shah. “However, if you take an antacid and the symptoms don’t get better, then that’s a sign you may need to seek medical advice,” he says.
• Does the pain stop if you change positions? Pain that only occurs when you’re in a certain position may indicate an issue other than a heart attack.

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Context also plays a critical role in understanding what may be causing your symptoms, says Kiran Mullur, MD, a family medicine and sports medicine physician at Atrium Wake Forest in Kernersville, North Carolina.

Evaluating the cause of chest pain often requires careful consideration of the full picture, rather than relying on a single symptom, says Dr. Mullur.

Heart attack symptoms are often different in women, which can make recognizing them more difficult and delay care.

Instead of classic chest pressure, women may be more likely to experience symptoms such as shortness of breath, fatigue, or pain in the chest, which can make it harder to tell if their symptoms are the result of a heart attack or heartburn, says Shah.

Mullur says that women often experience subtler warning signs than men that are easier to brush off or attribute to stress, illness, or digestive issues.

If you’re experiencing any symptoms that feel new, unusual, or out of the norm, Mullur recommends trusting your gut and either contacting your healthcare provider or calling 911.

While heartburn and heart attacks affect entirely different organs — despite its name, heartburn has nothing to do with the heart — they can trigger similar sensations due to how the body processes pain.

Not every episode of chest discomfort requires an emergency call, but many situations should be evaluated by your doctor sooner rather than later.

Contact your healthcare provider if you experience new or unexplained chest symptoms, even if they go away. Episodes that resolve on their own can still be warning signs, particularly if you’re unsure what caused them.

Chest discomfort that occurs with physical activity and improves with rest should also be evaluated, as that pattern may suggest a heart-related problem as well. Symptoms that increase in frequency or intensity over time are another reason to seek care.

“If your chest pain is new and you’ve never had chest pain before, you should talk to your doctor immediately,” says Mullur.

• Dizziness, which could indicate arrhythmia or a heart valve condition
• Heart palpitations or a heart racing
• Loss of consciousness, which could be a sign of a heart rhythm disorder
• Nausea, especially if you are a woman
• Shortness of breath or feeling winded more easily than usual

Some symptoms and situations require immediate emergency care, such as:

• Chest pressure, tightness, or squeezing that is severe, persistent, or not resolving
• Chest symptoms occurring alongside sweating, vomiting, shortness of breath, dizziness, or weakness
• Pain that spreads to the arm, shoulder, neck, jaw, or back
• Any new chest symptoms in people with a history of heart disease or a prior heart attack

Don’t worry about overreacting and don’t hesitate to call 911, says Mullur.

“If you’ve previously had a heart attack and you’re experiencing chest pain again, that warrants an immediate call for an ambulance,” he adds.

• Heartburn typically feels like a burning sensation rising toward the throat after eating — a heart attack is often described as pressure, squeezing, or tightness that can radiate to the arms, neck, jaw, or back.
• These conditions are easily confused because the heart and esophagus are located near each other and share similar nerve pathways, making it difficult for the brain to pinpoint the exact source of the pain.
• Women, as well as older adults, people with diabetes, and post-cardiac transplant patients, are less likely to experience “textbook” chest pressure and are more likely to have subtle warning signs like extreme fatigue, shortness of breath, or nausea, which can lead to dangerous delays in seeking care.
• Medical experts advise calling 911 immediately if chest discomfort is new, worsening, or accompanied by shortness of breath and sweating, as every minute counts during a cardiac event.