The Doctor Is In: Heart Attack Or Heartburn?

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(KPLR) – Many people reach for the antacids when they get heartburn. But is it really just heartburn? What if it’s something far more serious, and how would we tell the difference?

Dr. Sonny Saggar, who is an internist, urgent care physician and emergency physician, spoke with Christine Buck about some of these questions.

You can connect with Dr. Saggar, the Medical Director at St. Louis Urgent Cares, and ask him any questions you like.

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1. If it’s not acid reflux, what else could it be?

It could be a number of things, some very serious but others not serious at all.

The most worrisome problem could be a heart attack or symptoms that could eventually lead to a heart attack.

The pain caused by a lack of oxygen supply to the heart muscle, which is a result of blocked coronary arteries, is called angina.

Angina and Acid reflux can present similarly, because they share common nerve pathways to the brain, but there are other symptoms that can help you distinguish.

2. How can you tell the difference between heartburn and a heart condition?

With angina, you’ll get a tightness or pressure, but acid reflux is typically described as burning. Of course, people describe things in different ways, which makes it hard to tell the difference.

With angina, the discomfort is worsened with exertion; it can radiate to the neck, jaw or arms, and often associated with sweating, dizziness, nausea, shortness of breath and palpitations. These things are not usually associated with acid reflux.

Risk factors can help tell the difference, as smoking, diabetes, obesity, high blood pressure, high cholesterol and a family history of heart disease, all increase the chance of angina, but of all these, smoking and obesity are also associated with acid reflux.

Angina episodes will usually last less than half an hour, commonly just 10 minutes, heart attacks lasting longer and reflux often lasting several hours.

Acid reflux is often worse with a fatty or spicy meal and worse when laying down.

Remember there are always exceptions as some patients get angina after eating a big meal because blood flow is diverted from the heart for digestion. Due to the placebo effect, people who are having a heart attack and mistakenly believe they are experiencing heartburn may actually feel better after taking an antacid. Just to make it even more confusing.

Women and the elderly are more likely than middle-aged men to have unusual heart attack symptoms, for example women may have nausea, exhaustion, and a generalized tired feeling when they're having a heart attack. Elderly people may feel faint, out of breath, or just feel lousy.

3. When should someone go to the ER or St. Louis Urgent Cares?

The rule of thumb is ‘When in doubt, get it checked out’

If you’re having symptoms like chest discomfort but you’re not sure what to do, the ER is best if it ends up being a heart attack. Of course, it’s possible that it isn’t your heart and that’s fine. Nobody will judge you for going to the ER with acid reflux.

If you go to the urgent care center instead, they will also get an EKG, which is an electrical representation of how your heart muscle is working and will quickly transfer you by ambulance to the ER if it is indeed a heart problem.

You should seek immediate medical attention if you have chest tightness, break into a sweat, turn pale, become very weak, or faint.

I’d also recommend annual checkups for anyone with heart disease risk factors even if they aren't having any chest pain or discomfort, and more frequent visits for those with specific risk factors such as diabetes, hypertension, smoking, high cholesterol, all of which increase the risk of heart attack.

Of course, antacids will often help acid reflux but you might be overlooking a heart attack. Aspirin is the first drug used in an acute heart conditions but will not be great for acid reflux. It’s a risk-benefit situation. Not many people die from acid reflux!

If a heart attack is treated promptly—within 90 minutes of when symptoms start—the damage to heart muscle may be minimized. In terms of a heart attack, time is muscle, as we say in the urgent care and emergency medicine business.

4. How can you prevent heartburn or acid reflux?

Once heart disease is ruled out, only then should you look at how to reduce other causes such as acid reflux.

Reducing the above risk factors, such as smoking and obesity (which also cause heart disease), but also reducing spicy and smoked foods, reducing alcohol, not laying down for 3 hours after a meal, eating smaller meals.

5. And how can you prevent heart disease?

By adjusting modifiable risk factors such as smoking, high blood pressure, high cholesterol, better control of Diabetes, and of course eating healthier food and getting some daily aerobic (cardio) exercise.

Additionally, controlling one’s stress levels will help both acid reflux and heart disease, so the yoga and meditation are never a bad thing for a doctor to recommend.