Heartburn, the burning sensation in the chest, is a symptom of acid reflux caused by stomach contents flowing back into the esophagus. This discomfort is typically felt behind the breastbone and is often manageable with over-the-counter antacids. However, many other conditions, from benign muscle inflammation to life-threatening heart issues, can produce similar sensations of burning, pressure, or tightness in the chest. Differentiating true acid-related pain from these mimics is crucial for accurate diagnosis and appropriate care.
Critical Mimics: Heart and Circulation Issues
A lack of adequate blood flow to the heart muscle is one of the most concerning conditions mistaken for severe heartburn. This can manifest as angina (temporary chest pain) or a myocardial infarction (heart attack). Cardiac pain is typically described as a crushing, squeezing, or heavy pressure sensation, rather than just burning discomfort. This pressure often begins in the center of the chest and may spread to the jaw, neck, back, or arms.
The pain may intensify with physical exertion and is generally not relieved by antacids. Associated symptoms often include cold sweats, lightheadedness, nausea, or sudden shortness of breath. Because the esophagus and heart share nerve pathways, the body can misinterpret cardiac distress as digestive pain, necessitating immediate evaluation if symptoms are uncertain.
Esophageal Motility Disorders
The esophagus moves food to the stomach using a coordinated wave-like action called peristalsis. When this muscular function is disordered, resulting spasms can cause intense, non-acidic chest pain often confused with heartburn or a heart attack. Diffuse esophageal spasm involves uncoordinated and powerful contractions of the esophageal muscle.
This painful squeezing can be triggered by sudden temperature changes, such as drinking very cold or hot liquids, or by intense emotional stress. Achalasia is another condition where the lower esophageal sphincter muscle fails to relax, causing food to back up. This results in pain and severe difficulty swallowing. The intensity of pain from these motility disorders often requires ruling out a cardiac event.
Stomach Lining Inflammation and Ulcers
Burning pain can also originate lower in the digestive tract, specifically in the stomach or the beginning of the small intestine. Gastritis involves inflammation of the stomach’s protective lining. Peptic ulcer disease refers to open sores in the stomach (gastric ulcers) or the duodenum (duodenal ulcers). The pain is often described as a gnawing or dull ache, typically localized in the upper abdomen, just below the breastbone.
The timing of the pain distinguishes it from heartburn, which usually occurs right after a meal. Duodenal ulcer pain often appears when the stomach is empty, such as between meals or at night, and may be temporarily relieved by eating or taking antacids. Conversely, gastric ulcer pain may worsen shortly after eating as the stomach produces more acid for digestion.
Non-Internal Organ Causes of Chest Discomfort
Chest pain mimicking heartburn can also arise from issues outside the internal organs, specifically within the chest wall. Costochondritis is a common, non-cardiac cause involving inflammation of the cartilage connecting the ribs to the breastbone. This condition causes localized sharp or aching pain that often increases when the area is pressed, or when taking a deep breath or coughing.
A strain in the intercostal muscles, located between the ribs, can also produce sharp pain that intensifies with movement of the torso or arms. Anxiety and panic attacks can generate chest discomfort, often described as tightness or pressure, alongside symptoms like hyperventilation. These musculoskeletal and psychological causes are typically defined by pain that is reproducible by external touch or linked to emotional distress.
Determining When to Seek Immediate Medical Help
While many causes of chest discomfort are not life-threatening, certain symptoms require immediate emergency medical attention to rule out a heart attack or other severe condition. Seek emergency care without delay if chest pain is crushing, heavy, or feels like a vise gripping the chest. This is especially true if the discomfort spreads to the jaw, neck, shoulder, or arm.
Immediate consultation is necessary if the chest pain is accompanied by sudden symptoms. These include cold sweating, dizziness, lightheadedness, or significant shortness of breath. Persistent vomiting, passing bloody or black, tarry stools, or experiencing fainting alongside the pain are also serious warning signs. These symptoms indicate a potential medical emergency and should be treated as such, regardless of previous experiences with heartburn.