Heartburn or Heart Attack?

Heartburn or heart attack? Many patients can’t tell the difference.

Could you?

Decide quickly because, depending on what KIND of heart attack you have, your best chance for survival is getting to the hospital within the first three hours of your symptoms.

“Indigestion is a very common symptom,” said Dr. Josh Todd, the interventional cardiologist at Fort Sanders Regional Medical Center. “Many patients try to ignore it as much as they can. They’re taking antacids and everything else, and finally when it doesn’t go away, they decide to call an ambulance.”

In fact, a recent survey of 500 heart attack survivors found that eight out of 10 failed to realize that they were having a heart attack. Fully one third of those mistook their symptoms for indigestion. The study also found that half of heart attack sufferers do not seek help for more than an hour because they think they have indigestion or other minor conditions.

“It’s hard even for us doctors to tell,” said Dr. Todd. “That’s why stress tests exists, and that’s why we have all this great testing now. Risk factors are part of it. If you are a 20-year-old with no risk factors, meaning you don’t have diabetes and hypertension and you feel reflux, it’s probably reflux. But if you’re a male 45 to 65 range with diabetes and smoking and you are having these symptoms, I’d say get to the ER first.

“It’s not just a ‘I-have-a-chest-pain’ symptom – it’s chest pain in the right person with the right risk factors with all of the above, and still, we need an EKG to tell whether or not you are having a heart attack. There is no way for a patient to know.”

A big reason for that, said Dr. Todd, is that there are two kinds of heart attacks – STEMI and Non-STEMI. And only an electrocardiogram can tell which is which.

A STEMI heart attack is a combination of symptoms and an EKG tracing that shows elevated “ST” segments, indicating an artery is totally blocked. Cardiac enzymes also increase, meaning heart cell death is occurring.

“There is a lot of data showing that if you have that type heart attack, sooner is better because the artery is 100 percent blocked,” said Dr. Todd. “If the EKG doesn’t show that, then we can be a little more calm about things: We can admit you to the hospital, do the blood markers and determine whether a stress test or heart cath is needed. You have 24 to 72 hours to open up those arteries. So, an EKG is how we determine who gets rushed to the helicopter and who gets to hang out with us a little while. Those are the blockages we can get to without any problem.” 

“The STEMI heart attacks, where plaque ruptures and breaks loose from the wall to form a clot that blocks an artery, are hard to predict,” he added. “We don’t know how to predict that at all. You can have a normal heart cath today going by the book, and you can still have a heart attack the next day. It’s a completely different makeup. With STEMI heart attacks, sooner is better. The ‘golden window’ we have is the first three hours of onset of symptoms. After six hours, there’s very little benefit. Patients who recognize the symptoms and get to us within the first three hours, that’s the golden window for us to be able to help you.

“Pain intensity is not as important as the EKG findings,” said Dr. Todd. “Yes, mistaking a heart attack for heart burn is not uncommon. Reflux disease can present the same way. But for every one patient who is having a heart attack, there’s probably 10 with the same exact symptoms who don’t have anything. But only the EKG can tell you what kind of heart attack yours is.”