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Is your chest pain heart attack or heartburn? How to tell the difference?

I have had many patients come to the emergency with a heart problem, requiring either immediate medical or surgical intervention, primarily because they couldn’t understand if it was indeed a heart issue or acidity, gas and reflux. This dilemma had cost them a crucial diagnosis window. Considering that Indians have heavy meals at odd hours, many of them are prone to acid reflux and heartburn, which might trouble them, particularly at night. But sometimes these symptoms tend to mimic those of a heart attack and are often confusing. Given that most Indians are at a higher risk of heart disease than any other population, are already suffering from blood pressure or Type 2 diabetes, are overweight and may have a family history of heart disease, it is imperative that this high risk group understands the importance of medical referral. Particularly when a low level of medical awareness means that most patients lose out on the benefits of addressing the heart problem within the golden hour, simply because they mistake a heart episode or an angina pain as a gas attack. This compounds the risk of complications and scarring of heart tissue.

HOW CAN HEARTBURN BE A SIGN OF HEART ATTACK?

Sometimes chest pain may not be classically left-sided. Usually, a heart attack manifests as a pain in the left arm or the left part of the chest. But sometimes it may manifest as what we call a “referred pain,” which is a pain you feel in that part of your body which is away from the source of the pain. So, some heart attacks can manifest as a pain anywhere in the upper part of your torso, be it at the back, neck, jaw, teeth, shoulder and behind the breast bone. Sometimes a heart attack manifests as a burning sensation in the middle of your chest and even causes some sweating. You may think it is a heartburn but it could be caused by a reduced blood flow to your heart because of angina or an actual heart attack brought on by blocked arteries. In fact, heartburn, angina and heart attack may feel very much alike. You cannot tell the difference by just looking at physical symptoms. But if the symptoms are persistent, unusual to you, appear to be something that you haven’t experienced before, and are lasting beyond 15 minutes, then head to the emergency room of a hospital and take the tests to rule out a heart attack.

WHY ARE TESTS IMPORTANT?

Most people go to their general physician, who may not insist upon an ECG then and there. In fact, some doctors don’t. But a detailed investigation hastens diagnosis, which is confusing for even doctors when symptoms overlap. Even if symptoms seem to dull or subside, the doctor needs to study the patient’s medical history to check if acidity or gastro-intestinal issues have been an older problem. Then he should check the patient’s medical history and cross out risk factors — smoking, hypertension, diabetes, cholesterol, sedentary lifestyle, lack of physical exercise, dietary patterns, obesity and a family history of disease. Once this profile is checked, the doctor should assess the patient at the first point of contact and call for investigations. For example, if a 35- year-old smoker with cholesterol and diabetes shows up complaining of gas, I would definitely recommend tests and observe him for a couple of hours before dismissing him. Doctors should treat these overlapping symptomatic cases with the same urgency as you would do cardiac cases till they are proven otherwise. While I would not recommend a CT angio for every kind of investigation, which is not of great help for assessing the impact of calcified deposits, it can be used in such cases to rule out doubts.

WHAT TO DO IF YOU HAVE PERSISTENT CHEST PAIN AND ARE NOT SURE WHAT’S CAUSING IT?

Just visit the emergency room of a hospital and get your ECG done. Consult a doctor even if an unexplained chest pain of the kind you have not experienced before subsides within a few hours. Both heartburn and a developing heart attack can cause symptoms that subside after a while. The vanishing chest pain is an indicator of what could come later should it be proven that it had arisen from cardiac causes.AL


https://indianexpress.com/article/health-wellness/heartburn-vs-heart-attack-8562125/

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