Chest Pain in Women: Heartburn or Heart Attack?

A little heartburn may come after a big, greasy meal. But could that pain be a heart attack? Recognizing the differences between the two may help save your life. Read on to learn the symptoms, risk factors and triggers of each, and how to treat and prevent them. Plus, are you on the road to a heart attack? Take our quiz to find out…

In the middle of dinner, you feel a sharp chest pain. Is it a heart attack – or severe heartburn? The pain may feel similar, but the potential consequences are a matter of life and death. Unfortunately, too often women ignore the pain, making a potentially fatal mistake.

About 12 million Americans get heartburn once a month, according to the American College of Gastroenterology. Approximately 10,000 women 29-44 years old have a heart attack each year.

“People often confuse the symptoms of a heart attack and heartburn,” says Nieca Goldberg, M.D., chief of women’s cardiac care at Lenox Hill Hospital in New York City and author of Dr. Nieca Goldberg’s Complete Guide to Women’s Health. “Unfortunately, they usually think they have heartburn instead of a heart attack – this can be a tragic mistake.”

Both heartburn and a heart attack cause a feeling of pressure and a gnawing or burning sensation in the chest. But that’s where the similarity ends.

A heart attack occurs when the artery walls narrow, severely reducing the flow of oxygen and blood to the heart.

Heartburn, however, has nothing to do with your heart; it's a digestive problem. Acidic liquid from your stomach backs up into your esophagus and inflames its lining.

If you’re not sure which one you’re experiencing, go to the emergency room immediately. But here are a few tips to figure out what you have and get the right treatment:

Heartburn or Heart Attack? Symptoms to Watch for
Heartburn: When you experience heartburn – or acid reflux, the backup of the stomach's contents into your esophagus – you may feel a burning in the chest, an acidic or sour taste in the mouth or a sensation that you’re full. Other people have nausea, a dry cough or sore throat.
Unlike heart attacks, heartburn symptoms are similar for men and women.

Heart attack: The image of a woman gripping her chest and falling to the floor really isn’t what happens with a heart attack.

“In fact, only half the women who have heart attacks have chest pain, which is the most common symptom for men,” Goldberg says.

Unfortunately, women’s symptoms are more subtle and easy to miss. These include:

Pressure or burning feeling in the chest
Unexplained, extreme fatigue
Pain or discomfort that radiates to the arms, jaw, neck and/or back
Nausea, dizziness and/or vomiting
Breaking out into a cold sweat
Shortness of breath

Still not sure which it is?

Here’s a tip: “Pain that can be reproduced by changing position, pressing over the area of pain or that can be brought on by deep breathing or coughing is unlikely to be related to the heart,” says cardiologist Elizabeth Klodas, M.D., author of Slay the Giant: The Power of Prevention in Defeating Heart Disease and spokeswoman for the American College of Cardiology.

Then again, you might not feel pain, says Mary Ann Bauman, M.D., of the American Heart Association’s “Go Red for Women” campaign. You just may not feel like your usual self and that may be your heart talking to you.

Are you suddenly breathless while climbing stairs? It could be a sign that your heart isn’t getting enough oxygen, Bauman says.

What Are the Risk Factors?
Heartburn: Being pregnant increases your risk. In fact, almost 50% of moms-to-be get heartburn, especially in the second half of pregnancy, according to the American College of Gastroenterology.
Initially, the culprit is high levels of the hormone progesterone, which cause the muscle located between your esophagus and stomach to relax. In later months, heartburn is caused by the growing fetus pushing your stomach (and its contents) up toward your diaphragm.

Weight also plays a role.

“Obese women are six times more likely to develop heartburn than women of normal weight, but simply gaining weight has been linked to increased risk,” Goldberg says.

Additional risk factors include smoking and drinking too much alcohol.

Heart attack: High blood pressure or cholesterol levels, diabetes, family history, older age, and being a smoker and overweight can boost your risk of heart disease and, thus, a heart attack.

“If you’re at high risk for a heart attack, you need to be more cautious about the symptoms you’re experiencing, especially if they’re new,” cardiologist Klodas says.

In other words, don’t shrug off unfamiliar chest pain.

What Triggers Attacks?
Heartburn: The commercials for heartburn relief are right – eating can set off the pain. Certain foods can trigger heartburn, such as chocolate, peppermint, fried or spicy foods, sugar, caffeine, alcohol, and acidic fruits and veggies. These cause the lower esophageal sphincter (LES) muscle to weaken, which allows acid to flow up into the esophagus.

A peek into your medicine cabinet may also reveal possible sources.

“Both prescription and over-the-counter medications like aspirin, ibuprofen, Aleve, prednisone, iron, potassium can all cause heartburn,” Bauman says.

These drugs inhibit prostaglandin, a compound that protects the stomach’s lining from its acid.
Heart attack: You won’t get much warning with a heart attack. Often, they occur after exertion, such as shoveling snow, which causes blood pressure to rise and blood vessels to constrict.

But most heart attacks come out of nowhere.

Soothing the Pain
Heartburn: Although our instinct is to lie down and rest when we hurt, don’t: That exacerbates heartburn. Being horizontal causes stomach acids to flow back up into your esophagus.

Instead, stay upright for a few hours after eating. When you’re ready to sleep, keep your head above your stomach by resting on a wedge or elevating the head of the bed.

Mild heartburn symptoms can be soothed with over-the-counter antacids, such as Tums, which counteracts stomach acid.

“Some people find that drinking milk helps too,” Klodas says. But its relief is short-term: Milk may neutralize heartburn-causing acid, but its nutrients, particularly fat, will stimulate more production later.

Also, figure out which foods trigger the ‘burn, so you can avoid them.

Don’t chow down on a heavy meal before you hit the sack, eat smaller meals, quit smoking and "reduce stress because it increases stomach acid that can cause heartburn,” Goldberg says.

If you have heartburn more than twice a week, you may have gastroesophageal reflux disease (GERD), a condition characterized by chronic, persistent acid reflux.
See a doctor as soon as possible, because GERD is linked to more serious conditions, such as esophageal ulcers and bleeding, peptic stricture and Barrett's esophagus, which increases the risk of cancer. A physician can also prescribe stronger medications to reduce acid production.

Heart attack: Lying down may relieve discomfort from a heart attack, but it doesn’t stop it. If you think you’re having a heart attack, call 911 immediately.

“I can’t say it enough: Sometimes, it’s difficult to distinguish between heartburn and heart attack without performing an ECG [electrocardiogram] and laboratory tests,” Goldberg says. “See your doctor or go to the ER.”

In fact, two-thirds of women don’t go to the emergency room and that mistake can be fatal.

“Half the heart attacks that occur outside of the hospital are fatal because those first minutes are so crucial,” Goldberg says.

So even if you’re not sure that it’s heartburn or a heart attack, dial 911. Don’t drive yourself to the hospital or wait for someone to take you either, Bauman advises.

When you call 911, “treatment can begin immediately when the ambulance arrives and that’s important in order to limit the damage to the heart,” she says.

While waiting for the ambulance, chew a regular aspirin (325 mg tablet). Aspirin thins the blood and, as a result, may help dissolve the blood clot that’s causing the heart attack, Klodas says.
To prevent a heart attack:

Know your numbers. High blood pressure or cholesterol levels increase the risk for a heart attack, but you won’t know if you have either until you get a check-up. In a 2007 telephone survey of 524, 18- to 44-year-old women conducted by the Society for Women’s Health Research (SWHR), almost 20% said they never had their cholesterol tested or had not checked it in five years.

Put out your butts. Nicotine deprives the body of oxygen, speeds build-up of plaque in arteries and lowers high-density lipids (HDL), or “good” cholesterol.

Keep your weight in check. Being overweight or obese makes your heart work a lot harder.

Break a sweat. Exercising helps your ticker, even if you don’t lose a pound. A Harvard Medical School study found that participants who did physical activity (formal workouts as well as gardening, walking to work and taking the stairs) just one to two hours per week reduced their risk of heart disease by 27%, 2-5 hours reduced it by 32% and more than five hours decreased it by 41%.

Are You on the Road to a Heart Attack?
Coronary heart disease, the leading cause of death in this country, contributes to the 1.5 million heart attacks that occur each year. Will you become a part of this statistic?