Heartburn or Heart Attack? How to Tell Chest Pain Apart

Mansaf at a family gathering, a late-night falafel sandwich with extra chilli, or a big iftar in Ramadan, followed by that familiar feeling: a burning rising up the chest. Most of the time it is just heartburn. But heart pain can disguise itself as indigestion, and getting it wrong in the dangerous direction can be costly. This guide explains how heartburn and a heart attack usually differ, why those differences aren't always enough, and when to call 911 without hesitating.

Can spicy food give you a heart attack?

The short answer: there is no good evidence that spicy food causes heart attacks. It is, however, one of the most common triggers of heartburn, and it can cause a real, burning chest pain. The mistake many people make is assuming that any chest pain after a spicy meal must be the food. A heart attack can happen after any meal, especially a large one, and some people feel it as indigestion. If your pain is different from your usual heartburn, don't assume it's the chilli. For when reactions to spicy food become an emergency, see our guide to spicy food symptoms that need the ER.

What does heartburn or acid reflux chest pain feel like?

Heartburn happens when stomach acid flows back up into the oesophagus, the tube that carries food from your mouth to your stomach. According to the NHS, the typical signs are:

• A burning feeling in the middle of the chest behind the breastbone, sometimes rising toward the throat.
• A sour or bitter taste in the mouth, or food or liquid coming back up.
• It starts after eating, when bending over or lying down, and is often worse at night.
• Burping, bloating and mild nausea, and sometimes a persistent cough or hoarse voice.
• It usually eases with an antacid or by sitting upright.

Common triggers include spicy, fatty and fried food, large meals, coffee and strong tea, chocolate, tomatoes and citrus, smoking (including shisha), being overweight, stress and pregnancy. Some medicines, such as anti-inflammatories like ibuprofen, can make it worse.

What does a heart attack feel like?

A heart attack happens when blood flow to part of the heart muscle is blocked, and every minute before treatment matters. The NHS and MedlinePlus usually describe it as:

• Pressure, heaviness, squeezing or tightness in the chest, not necessarily a sharp pain.
• Pain spreading to the arms (often the left), jaw, neck, back or upper stomach.
• Breathlessness, a cold sweat, nausea or vomiting, and dizziness.
• An overwhelming feeling of anxiety or that something is very wrong.
• It lasts more than a few minutes, or comes and goes, and doesn't ease with rest.

For the full list of early signs, see heart attack warning signs. If the pain comes with a racing heart and tingling hands after something stressful, it may be a panic attack, but that can't be confirmed at home; see panic attack or heart attack.

Women, people with diabetes and older adults: atypical symptoms

Not every heart attack looks like the films. Women are more likely to have breathlessness, nausea, pain in the back, jaw or upper stomach, and unusual exhaustion, sometimes with only mild chest discomfort or none at all. People with diabetes and older adults may feel little or no pain, so a heart attack can show up as dizziness, breathlessness or just feeling generally unwell. These symptoms are often blamed on indigestion, which is why the rule is the same for everyone: if in doubt, call 911.

Heartburn, heart attack or something else? A quick comparison

The table is a general guide, not a way to diagnose yourself. Symptoms overlap a lot, and the same person can have both reflux and heart disease. A heart attack can't be ruled out from symptoms alone; that needs a medical assessment.

When is chest pain after eating an emergency?

Call 911 for

• Chest pain, pressure or tightness lasting more than a few minutes, or that comes and goes.
• Chest pain spreading to the arm, jaw, neck or back.
• Chest pain with breathlessness, sweating, nausea or dizziness.
• "Heartburn" that feels different or worse than usual, especially if you have diabetes, high blood pressure or smoke.
• Vomiting blood or material that looks like coffee grounds, or fainting.

Don't drive yourself and don't wait for an antacid to work. The call handler may advise chewing aspirin if you're not allergic to it.

Go to the ER now

• Severe, constant pain under the right ribs with fever, shivering or yellowing of the skin or eyes.
• Black, tar-like stools, or sudden severe stomach pain.
• Food that feels stuck and you can't swallow your own saliva.

Urgent care or a doctor the same day

• Bouts of pain under the right ribs after fatty meals, even if they settle.
• Difficulty or pain swallowing, or food repeatedly feeling stuck.
• Heartburn with unexplained weight loss or repeated vomiting.

Usually fine at home

• Your usual heartburn, feeling the same as always, after a known trigger, and easing with an antacid.
• No breathlessness, sweating or spreading pain.
• See a doctor if you've had heartburn most days for three weeks or more.

For a wider look at all the causes of chest pain, see chest pain: when to go to the ER, and if the pain is more in your stomach than your chest, our guide to stomach pain explains when it's serious.

How can you ease heartburn at home?

These tips are for known heartburn only, not for new or unexplained chest pain. They are based on NHS and MedlinePlus advice:

• Eat smaller meals slowly, and don't eat in the two to three hours before bed.
• Stay upright after eating, and raise the head of your bed slightly if heartburn comes at night.
• Cut down your triggers: spicy, fatty and fried food, coffee, fizzy drinks, smoking and shisha.
• Pharmacy antacids can ease symptoms; ask the pharmacist which suits you, especially if you're pregnant or take other medicines.
• Lose excess weight and avoid tight clothing around the waist.

Iftar and heartburn in Ramadan

After a long day of fasting, the temptation is to eat a lot quickly, then have tea and lie down. That is a near-perfect recipe for reflux. Break the fast with water and dates, pause before the main meal, go easy on fried and spicy dishes, and don't lie down for at least two hours. And remember that fasting is never a reason to delay help: pressure-like chest pain after iftar is treated like any other chest pain.

What happens when you come to Emergency Plus?

At the emergency department at Emergency Plus in Dabouq, an emergency physician on site 24/7 assesses you without an appointment. They ask about the pain, when it started and what makes it worse, examine you, and may request tests from the on-site laboratory, an X-ray or an ultrasound depending on your symptoms. If your symptoms sound like a heart attack, call 911 first rather than driving to us.

Sources

• NHS — Heartburn and acid reflux
• NHS — Heart attack: symptoms
• MedlinePlus — Heartburn
• Cleveland Clinic — Heartburn
• NHS — Gallstones