Heartburn is the common term for the uncomfortable, burning sensation felt in the chest when stomach acid flows backward into the esophagus (gastroesophageal reflux). While millions experience this digestive discomfort, many other medical conditions can produce pain that feels remarkably similar to acid reflux. This overlap often leads to confusion and misdiagnosis, making it difficult to discern a benign issue from a medical concern. Understanding the subtle differences in pain quality, timing, and accompanying symptoms is important for correctly identifying the true source of chest discomfort.
Cardiac Pain How It Differs
Chest pain originating from the heart, often described as angina, frequently mimics severe heartburn. Angina occurs when the heart muscle does not receive enough oxygen-rich blood, usually due to narrowed coronary arteries. Unlike the burning of acid reflux, cardiac pain is reported as intense pressure, tightness, or a heavy squeezing sensation in the center of the chest. This discomfort feels like a weight sitting on the chest rather than a fiery burn.
A distinguishing factor in cardiac pain is its relationship to physical exertion or emotional stress. Pain that consistently worsens with activity (such as walking up stairs) and improves with rest is highly suggestive of a heart-related issue. Heart attack pain (myocardial infarction) may also be accompanied by a unique pattern of radiation. The discomfort frequently spreads beyond the chest to the jaw, neck, back, or down one or both arms.
Heart-related chest discomfort is often accompanied by systemic symptoms less common with simple heartburn. These include shortness of breath, lightheadedness, dizziness, nausea, or a cold sweat. These signs suggest a systemic response that goes beyond localized digestive irritation. Heart-related pain also tends not to improve quickly with antacids, which typically provide rapid relief for heartburn.
Digestive System Problems That Feel Like Heartburn
Beyond simple acid reflux, other digestive tract conditions can cause pain localized to the chest area. Peptic ulcers (sores on the lining of the stomach or upper small intestine) produce a burning or gnawing pain in the upper abdomen. This pain may be confused with heartburn because the upper abdomen sits directly below the breastbone. The timing of the pain provides a differentiating clue: ulcer discomfort may worsen when the stomach is empty or be relieved by eating certain foods.
Inflammation of the stomach lining, known as gastritis, causes a dull or burning sensation in the upper abdomen that can radiate. This condition shares symptoms like bloating, early satiety, and nausea with acid reflux. The discomfort from gastritis is located primarily in the abdomen, while true heartburn is felt higher up, behind the breastbone. Both peptic ulcers and gastritis are frequently caused by Helicobacter pylori infection or the long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs).
Gallbladder issues, such as gallstones or inflammation (cholecystitis), can cause intense pain often mistaken for severe heartburn. Although the gallbladder is in the upper right abdomen, its pain can radiate to the center of the chest, the right shoulder, or the back. A tell-tale sign is that the pain often begins after consuming a heavy or high-fat meal, as the organ contracts to release bile. Unlike heartburn, which resolves quickly with antacids, gallbladder pain typically lasts for several hours and does not respond to acid reducers.
Non-Digestive Causes of Chest Discomfort
Chest discomfort can stem from sources outside the heart and major digestive organs, including the esophagus, musculoskeletal system, and nervous system. Esophageal motility disorders, such as spasms, involve uncoordinated muscle contractions in the tube connecting the throat to the stomach. The resulting pain can be intense, sometimes described as a severe, squeezing pressure that closely mimics a heart attack. This pain is often triggered by swallowing, especially very hot or very cold foods, and may be accompanied by difficulty swallowing.
Musculoskeletal pain, specifically costochondritis, is a common cause of non-cardiac chest pain. Costochondritis is the inflammation of the cartilage connecting the ribs to the breastbone. The pain is typically sharp or aching and localized to a specific spot on the chest wall that is tender to the touch. Pressing on the affected area, or movements like coughing, deep breathing, or twisting the torso, will reproduce or worsen the discomfort. This tenderness is a key difference from both cardiac pain and heartburn.
Episodes of intense anxiety, commonly known as panic attacks, can generate a powerful physical response that feels identical to a heart problem. The sudden release of stress hormones causes physical symptoms such as a racing heart, chest tightness, shortness of breath, sweating, and dizziness. While heart attack pain is often a deep pressure that builds, panic attack pain is sometimes described as sharp or shooting, peaking quickly before resolving within 10 to 30 minutes.
Warning Signs That Require Immediate Medical Attention
Given the significant overlap in symptoms, any new or unexplained chest pain should be evaluated by a medical professional. However, certain “red flag” symptoms indicate a potentially life-threatening emergency, such as a heart attack, requiring an immediate call for emergency services. This includes a sudden onset of severe, crushing pressure or tightness in the chest that lasts longer than a few minutes.
Immediate help is warranted if chest discomfort is accompanied by pain radiating to the shoulder, arm, back, neck, or jaw. Other concerning signs include shortness of breath, nausea, vomiting, or a cold sweat occurring alongside the chest pain. If you experience fainting, unexplained lightheadedness, or a rapid, irregular heartbeat with the pain, seek emergency care immediately. If there is any doubt about the cause, it is advisable to treat the symptoms as a medical emergency to ensure timely intervention.