Is It Really Heartburn? When to See Your Doctor
So similar are some of the symptoms of heartburn, angina pectoris, and heart attack that sophisticated medical tests may be needed to distinguish one from the other. In other words, if you’re in doubt, seek medical attention immediately.
That said, there are some signs that may make it easier to pinpoint the source of your chest pain. Once again, however, if you’re still not sure, it’s better to be safe rather than sorry, meaning that expert medical opinion should be sought to eliminate any doubt.
Heartburn Is a Misnomer
As you probably know, heartburn is a bit of a misnomer, because it has nothing at all to do with the heart and is really a symptom of a fairly common digestive disorder known as acid indigestion or GERD (gastroesophageal reflux disease). The term heartburn describes the chest pains this digestive disorder causes, which typically manifest themselves as a burning pain just behind your sternum, or breastbone.
Other signs and symptoms of heartburn, according to MayoClinic.com, include:
- Burning in the throat or the presence of acidic, sour, or salty-tasting fluid at the back of the throat;
- Difficulty swallowing;
- Chest pain that worsens when you’re lying down, bending over, or just after eating;
- A feeling that food is sticking in the throat or middle of the chest;
- Symptoms usually ease noticeably after you’ve taken antacids;
- Pain usually doesn’t radiate to the shoulders, neck, or arms, but it can do so in some cases; and
- Pain is rarely accompanied by a cold sweat.
In contrast, symptoms more closely associated with a heart attack are as follows:
- Sudden chest pain or pressure that worsens;
- Possible lightheadedness;
- Shortness of breath;
- A sensation of tightness, fullness, pain, or dull pressure in the center of the chest;
- The feeling of a belt tightening around your chest;
- Pain that spreads to the jaw, shoulders, neck, or arms;
- Pain accompanied by a cold sweat; and
- Pain that responds quickly to nitroglycerin.
Because of the overlap between the symptoms of heartburn, angina, and heart attack, your wisest course of action is to seek medical attention if you have any doubt about the cause of your symptoms. If, however, you have long suffered from acid indigestion or GERD and recognize the symptoms to be those you ordinarily experience from those conditions, you can usually safely assume that you’re dealing with a gastrointestinal problem and not a cardiac emergency.
How GERD Causes Pain
GERD is a condition in which your stomach contents leak backwards from your stomach into your esophagus, which is the tube that carries food, liquids, and saliva from your mouth into your stomach. This reflux, or reverse flow of stomach contents, is normally prevented by a ring of muscles at the base of the esophagus that is known as the lower esophageal sphincter, or LES.
Over time, the LES may not work as thoroughly as it once did, thus allowing some of the stomach’s contents, including food, beverages, and acidic gastric juices, to leak back into the esophagus. This causes a painful irritation of the esophagus, giving rise to heartburn. Allowed to continue untreated for an extended period, GERD can cause significant tissue damage to the esophagus.Hiatal Hernia
One fairly common cause of GERD is hiatal hernia, a condition that occurs when the top part of the stomach moves upward into the chest through an opening in the diaphragm — the muscle that separates the abdomen from the chest. While not all hiatal hernia sufferers experience GERD, the condition may make it easier for stomach contents to reflux into the esophagus, according to WebMD.com.
Angina pectoris is a medical term used to describe the chest pain or discomfort caused by an insufficient flow of blood to the heart because of coronary artery disease. The pain of angina is most likely to be experienced upon physical exertion, which increases the heart’s need for oxygen. Angina is unlikely to be experienced when you are at rest, and the symptoms of angina usually ease quickly if the patient takes a nitrate-based drug to dilate the blood vessels supplying the heart or sits down and rests.
Other Angina Triggers
In addition to physical exertion, angina attacks may be triggered by eating a heavy meal, exposure to extreme cold or hot temperatures, smoking, or emotional stress.
Unlike the chest pain associated with a heart attack, the pain of angina is usually of short duration (five minutes or less), doesn’t usually come as a surprise but rather as the natural consequence of physical activity or stress, and tends to mirror similar attacks in the past, according to the American Heart Association.
However, like a heart attack, angina pain may radiate to the back, arms, or other areas of the body. And angina can also cause discomfort similar to that of gas pain or indigestion.
Stable Angina Easy to Manage
Also known as stable angina, angina pectoris is fairly predictable and easy to manage. Rest and/or nitroglycerin usually quickly relieves the discomfort of angina. However, the American Heart Association warns, if you begin to experience chest pain more often and with less exertion than has been the case in the past, you may be seeing the early signs of unstable angina, also known as acute coronary syndrome.
Unstable angina causes unexpected chest pain and usually occurs when you are at rest. Unlike stable angina, this form of the disorder should be treated as a medical emergency. The most common cause of unstable angina is blood clots that either partially or fully block an artery that supplies the heart. According to the AHA, ¨blood clots may form, partially dissolve, and later form again, and angina can occur each time a clot blocks blood flow in an artery.¨Unstable Angina Symptoms
Other signs and symptoms of unstable angina may include chest pain that lasts longer than that of stable angina, is not relieved by rest or medication, and gets progressively worse. Attacks of unstable angina sometimes lead to full-blown heart attacks, which is one of the reasons these symptoms demand immediate medical attention.
In order to treat unstable angina, your cardiovascular physician first needs to perform a cardiac catheterization to find the location of the clot(s) blocking the coronary arteries. To do this, a catheter is usually introduced into your body through an incision in an artery in the groin or arm. The catheter is then threaded through the circulatory system until it reaches the coronary arteries. At this point, a liquid dye is injected through the catheter, allowing those performing the test to take X-rays as the dye passes through the arteries that show the presence of any blockages and also indicate how well the heart is functioning overall.
Treatment of Unstable Angina
Treatment of unstable angina usually takes one of two forms, depending on the extent of blockage to the coronary arteries. The most common treatment for a blockage in a single artery is percutaneous coronary intervention, or PCI, which consists of a cardiac catheterization to find the blockage and the introduction of a secondary catheter with an inflatable balloon at its tip. When the blockage is located, the balloon tip is inflated, thus squeezing open the fatty plaque deposit that has caused the blockage. In some cases, a stent is then inserted to help keep the artery open, providing strong blood flow to the heart.
Alternatively, doctors may perform coronary artery bypass surgery in which a synthetic blood vessel or one harvested from elsewhere in the body is used to bypass the blockage and thus ensure uninterrupted blood flow to the heart.
Don Amerman is a freelance author who writes extensively about a wide array of nutrition and health-related topics.