Heartburn or Heart Attack? Pay Attention to Symptoms

**By Gordon L. Kritzer, MD, FACC**

heartattackSince large meals are often part of celebrating, it’s easy to overdo it on special occasions. If you’ve just eaten a big meal and you feel a burning sensation in your chest, you might think it is heartburn, and it might be. However, there is a chance that the chest pain could be caused by reduced blood flow to your heart (angina), or an actual heart attack.

What is heartburn?

Heartburn, often called acid indigestion, is discomfort or actual pain caused by digestive acid moving into the esophagus, which carries swallowed food to your stomach.

Signs of classic heartburn are:

  • A burning sensation starting in the upper abdomen and moving up into the chest after eating, or while bending over or lying down.
  • Symptoms that awaken you from sleep, especially if you have eaten within two hours of going to bed.
  • Symptoms that are relieved by antacids.
  • Getting a sour taste in your mouth, especially when lying down.
  • A small amount of stomach contents rising up into the back of your throat (regurgitation).

Common confusion

Despite its name, heartburn is related to your esophagus, not your heart. But because the esophagus and heart are located near each other, either one can cause chest pain that sometimes radiates to your neck, throat or jaw. This is why many people mistake heartburn for angina and vice versa.

Since heartburn, angina and heart attack may feel very much alike, even experienced doctors cannot always tell the difference from your medical history and a physical exam. That is why if you go to an emergency department for chest pain, you will immediately have tests to rule out a heart attack.

What to do if you’re unsure

I often tell patients that if you burp and symptoms go away, it probably isn’t related to your heart, but to your esophagus. However, if you suddenly experience shortness of breath and sweating or persistent chest pain, then it’s likely a heart-related issue and you should call 911 immediately.

Also, call your doctor if you had an episode of unexplained chest pain that went away within a few hours. This is important because both heartburn and a developing heart attack can cause symptoms that subside after a while. The pain does not have to last a long time to be a warning sign.

Heart attack vs. sudden cardiac arrest

It is also important that people are able to recognize the difference between a heart attack and sudden cardiac arrest. When someone is having a heart attack, he or she is conscious and might complain of chest pain or other symptoms.

When a person is experiencing sudden cardiac arrest, the heart has unexpectedly stopped beating and blood is no longer pumping throughout the body or brain. The individual may lose consciousness and appear lifeless. Some victims gasp and shake as if they are having a seizure. Death can occur within minutes.

If someone is experiencing heart trouble, here are five ways to help them:

  • Call 911. Whether it is a heart attack or sudden cardiac arrest, step one is always to call 911 to report the emergency and allow emergency dispatchers to coach you through some simple, potentially lifesaving steps.
  • Ease strain on the heart. If the person is conscious and possibly suffering a heart attack, help move them into a comfortable position – half-sitting, with head and shoulders well supported and knees bent, to ease strain on the heart. Also, loosen clothing at the neck, chest and waist.
  • Have the person chew and swallow an aspirin. If the person is conscious, give them a full dose (300 mg) of aspirin. Have the person chew it slowly so it dissolves and is absorbed into the bloodstream more quickly when it reaches the stomach. Aspirin helps break down blood clots, minimizing muscle damage during a heart attack.
  • Perform cardiopulmonary resuscitation (CPR). If the person is unconscious, the next step is to start chest compressions. To do this, press down hard (about two inches deep) and fast (100-120 times per minute) on the center of the chest.
  • Look for an automated external defibrillator. These commonly found devices have clear instructions and are designed for use by the public. To use one, simply attach the pads as indicated on the machine, then it will talk you through the process. It will only deliver a shock if the patient’s condition warrants it. Leave the machine switched on at all times, and leave the pads attached – even if the patient has recovered.

Awareness is key

Learning to recognize simple heartburn and the symptoms of a serious heart condition will help you act quickly when it matters most. Knowledge is power as we become better health advocates for ourselves and for others.

Gordon L. Kritzer, MD, FACC, is a board certified cardiologist who specializes in interventional and invasive cardiology as well as cardiac rehabilitation. He practices in the Heart Institute at Virginia Mason Hospital and Seattle Medical Center (206-341-1111). For more information, watch Dr. Kritzer’s “Signs of a Heart Attack” video.


Ask a GI Dietitian: Staying Healthy This Summer

by Samantha Woodward, Digestive Disease Institute **

Debra Clancy, RD, CD, is a registered dietitian who works with patients within Virginia Mason’s Digestive Disease Institute providing nutrition information and tools for making positive changes in their lives. In a recent chat, she gave us the inside scoop on how to make healthy choices when you are out and about this summer and surrounded by meat in buns and ice cream on cones.

If I’m trying to stay healthy this summer, what types of foods should I eat more of and what foods should I avoid?

Clancy: Instead of avoiding some of your favorite summer foods, modify their ingredients and eat smaller portions. Make small, but significant, changes to summer food recipes like decreasing fat and sugar content by using low-fat products or decreasing the amount of sugar in a recipe.

A healthy summertime meal from the grill.

A healthy summertime meal from the grill.

The typical summer gathering with family and friends lasts for several hours, so try going back to the buffet more often, each time taking small amounts of food instead of overfilling your plate on a single trip. Choose side-dishes, salads that have a vinaigrette dressing, or very little mayonnaise, and meat items that have the skin removed or have minimal sauce covering them.

At your next ballgame, don’t order deep-fried foods – or try to split a dish with someone. Other healthy choices include ordering a smaller size beverage or water. When it’s time for dessert, try a small amount, scrape off the frosting and eat just the cake or choose a fruit dish instead. Choose mineral waters or flavored waters instead of sugar-sweetened beverages.

Don’t forget to exercise by walking and participating in activities that increase your heart rate for at least 30 minutes daily.

What food choices can I make to help prevent indigestion?

Clancy: If you are prone to indigestion, the symptoms are often increased when a large meal is spicy, acidic or high in fat. Spicy foods may be the BBQ sauce on the grilled chicken breast. Tomatoes are examples of acidic foods. High fat foods include cream dishes, deep-fried items and salads with lots of mayonnaise.

Follow these simple tips to minimize heartburn:

  • Eat green salads with minimal dressing, skinless turkey and chicken, fish and seafood, melons and bananas, and root vegetables, such as carrots and potato.
  • Choose low-fat dairy products as supplements to the meal, not as the main item.
  • Eat small amounts of food over a number of hours during the event.
  • Remain sitting upright for one to two hours after each meal.
  • Avoid carbonated sodas, alcohol, chocolate and large amounts of caffeine.
  • Weight loss often improves indigestion symptoms and decreases the progression to GERD, or gastroesophageal reflux disease.

Indigestion becomes GERD when your discomfort lasts for a longer period of time or when it occurs with each meal. If you are following the above suggestions and your symptoms persist, it’s best to seek medical advice.

When it’s your turn to be the host this summer, search online for healthy alternative recipes for your favorite foods:

Enjoy your summertime BBQ’s and events!

7 Ways to Prevent GERD

Gastroesophageal reflux disease (GERD) can wreak havoc on your body and ruin a food-filled celebration. While there are very successful medical treatments for GERD, many times you can actually prevent GERD from happening in the first place:

  1. Eat smaller, more frequent meals. A full stomach can put extra pressure on the esophageal area, which will increase the chance that some of this food will reflux into the esophagus.
  2.  Limit your intake of acid-stimulating foods and beverages. Many foods such as citrus juices, onions and high-fat red meats can cause your body to produce more acid, while safer foods such as apples, whole grains and low-fat white meats are better for you.
  3.  Don’t go to bed with a full stomach. Having your last meal at least two to three hours before bedtime allows your body to digest foods and results in acid levels going down before you call it a night.
  4.  Maintain a reasonable weight. Obesity increases abdominal pressure, which can then push stomach contents up into the esophagus. Even a 10 percent decrease in body weight can do wonders for preventing GERD.
  5.  Quit smoking. Smoking also stimulates the production of stomach acid and can cause muscles in the esophageal area to relax, causing GERD. If you smoke, speak with your provider about proven ways to quit the habit.
  6.  Avoid alcohol. Alcohol can irritate the lining of your stomach and cause overproduction of stomach acids. If you suffer from GERD, consider eliminating alcohol from your diet and drink water, which reduces symptoms of GERD.
  7.  Keep a heartburn record. Record what triggered your acid reflux episodes, the severity of each episode, how your body reacts and what gives you relief. You can take this list to your provider to help develop a plan for managing GERD, so you can enjoy food and activities without the burn.

Are you curious what causes GERD and how different foods affect Gastric Gayle? Play Reflux: The Food Impact Game, an interactive game that can help you make the right food decisions.


This article originally ran in Team Medicine NewsFlash.