Heartburn, heart attack or angina?

In response to a question on healthshare.com.au

For the last several days my mum keeps feeling a pain in her chest. How do we tell if the pain is associated with heartburn, a heart attack or angina? It is not a severe pain but as it has not gone away it is starting to worry us. What are the different sensations?

Having pain in the chest may be a sign of a life-threatening medical emergency or the sign of something less urgent, but how do you tell?

First of all, let’s briefly describe some of the conditions which can manifest with chest pain… Heart attack (or more formally, a “myocardial infarction”) is where the small blood vessels going to the heart are blocked and the heart muscle itself is starved of blood supply and dies. Angina is very similar, but is a warning sign that the heart muscle is at risk but has not died yet. Both are clearly medical emergencies. Typically, the pain is under the breastbone, sometimes radiating into the left arm or jaw, and feels crushing in nature, often said to be like an elephant sitting on your chest.

Heartburn from gastro-oesophageal reflux disease (GORD), oesophageal spasm and oesophageal motility disorders (such as achalasia) can cause similar symptoms of chest pain, and so too can gallbladder problems, pneumonia or stomach ulcers. These can be serious, but do not usually have the same urgency as heart problems. GORD usually causes a burning type pain, without radiation into the arm or jaw. Achalasia is usually associated with difficulty swallowing. Gallbladder problems and oesophageal spasm can feel exactly like a heart attack.

It is frequently difficult to tell the different conditions apart. The bottom line is, if you are worried, you need to call an ambulance and attend the nearest emergency department. Your doctor’s first job will be to check your heart with an ECG and some blood tests. Once the heart is cleared, attention can be directed elsewhere. Specific tests such as oesophageal manometry testing can be performed in a Gastrointestinal Physiology Laboratory to help clarify the source of the pain.