Heart Attack vs Heartburn- When to worry?

As a Cardiologist, I have noted that the commonest reason why my patients with a heart attack reach late in the hospital is because they have initially mistaken their complaints to be due to heartburn or acidity. Reaching late to a hospital means that we may lose the golden hours in which these patients may receive the maximum benefit of treatment. Also, delayed diagnosis of heart attack means that some of these patients develop serious complications and few unfortunate ones may not even reach the hospital.

Hence, as a community, it is essential that all of us are aware of differences in heart attack and heartburn/acidity and know when to be alert and bring our complaints to the attention of our doctor. Let us first understand what these conditions mean-

Heart Attack

A medical emergency which occurs when the blood supply to the heart is interrupted by blockage of one of the blood vessels supplying the heart.

Typical heart attack signs and symptoms include:

• Pressure, tightness, pain, or a squeezing or aching sensation in your chest or arms that may spread to your neck, jaw or back
• Nausea, indigestion, HEARTBURN or abdominal pain
• Shortness of breath
• Cold sweat
• Lightheadedness or sudden dizziness

Heartburn

Is discomfort or actual pain caused by digestive acid moving into the tube that carries swallowed food to our stomach.

Typical features of heartburn include:

• Starts as a burning sensation in the upper abdomen and moves up into the chest
• Usually occurs after eating or while lying down or bending over
• Is usually relieved by antacids
• May be accompanied by a sour taste in mouth — especially when lying down
• May be accompanied by a small amount of stomach contents rising up into the back of throat (regurgitation)

Unfortunately, certain features of heart attack and heartburn overlap and hence, it is easy to mistake one for the other. Certain subset of people are also more prone to have symptoms of ‘acidity’ as a presentation of heart attack. These include-

• Diabetics
• Women
• Elderly patients, especially the ones more than 75 years of age.

It is thereby important that we are aware of certain red flags that should make us immediately get our ‘heartburn’ attended to by our doctor/ Cardiologist. These warning signs are-

• ‘Acidity’ accompanied with breathlessness/ unusual uneasiness/ sweating/ giddiness.
• ‘Acidity’ that worsens on exertion.
• ‘Acidity’ that awakens one from deep sleep or which happens in early morning hours.
• ‘Acidity’ that does not respond to the usual medications/ is much more severe than ever before.
• Postprandial angina is a known entity where chest discomfort happens after a heavy meal, especially if followed by a walk and this is commonly mistaken as heartburn.

Many patients have one or more of these warning signs days to weeks before a major heart attack, but these are ignored.

Tests which are helpful-

It is also very improtant to know that even experienced doctors/ Cardiologists may find it difficult to differentiate beween heart attack and acidity only on the basis of symptoms or a physical examination. Hence further tests are needed in a good number of patients to be certain regading the diagnosis. These are as follows-

• Blood tests– A blood test called Cardiac Enzymes is often used in a patient suspected to have a heart attack. Results are available in a few minutes to an hours time depending on the type of test done. Significantly abnormal values almost always mean that we are dealing with a cardiac issue.
• ECG- The most basic test done in almost all patients who come to Emergency services with chest pain. It is an electrical representation of cardiac activity and if abnormal, it is a pointer to further evaluation. However, an apparently normal ECG does not always mean that a heart problem is ruled out.
• 2D Echocardiogram– It is a sonography of the heart and used as a bedside test in all well equipped hospitals to look for abnormality in pumping of the heart that may happen in a heart attack and also to rule out other abnormalities in heart valves or other structures in the heart.
• Treadmill Test/ Stress Test- This test should never be done in the presence of ongoing chest pain or when there is any suspicion of a heart attack. However, it can be very helpful in evaluation of patients with stable and prolonged complaints of exertional sypmtoms. Symptoms or ECG changes that worsen on physical exertion which is demonstrated in this test are a strong pointer towards heart disease.
• CT Coronary Angiography– CT scans can now be done to detect calcium deposition in the blood vessels supplying the heart as well as to visualise these vessels to detect blockages within them. This is a very useful test in patients less than 60-65 years of age and is very accurate in ruling out a heart related issue if this report is normal.
• Coronary Angiography– This is the gold standard test used to detect blockages in the blood vessels of the heart. Once the problem is detected and found to be severe, it can be treated at the same time by doing an Angioplasty of the affected vessel.
• Endoscopy of the oesophagus (food pipe)– Done in patients with heartburn to visualise the food pipe and stomach. This test can also be used to collect samples from these sites which can be helpful in further analysis of acidity.

Take home message

Do not self diagnose or self medicate when in doubt. A litttle more caution and awareness may make all the difference between life and death.

Sometimes ..Dont Stay Home and Save Lives!