Heart Attack vs Heartburn: How to Tell the Difference
Both can burn in the middle of your chest. The differences that matter, the red flags that mean 999, and the other causes of burning chest pain worth knowing.
Part of the Complete Acid Reflux Guide.
Emergency notice: If you have chest pain or tightness and are unsure of the cause, call 999 immediately. Do not drive yourself to hospital. Because heart attack and heartburn can feel similar, treat unexplained chest pain as a potential emergency until proven otherwise.
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Even experienced clinicians sometimes struggle to separate these two on symptoms alone, but several features consistently point one way or the other:
| Feature | Heartburn (acid reflux) | Heart attack |
|---|---|---|
| Typical trigger | Eating, lying down, fatty food, alcohol | Any time; no trigger needed |
| Relieved by antacids? | Yes — usually promptly | No effect |
| Chest sensation | Burning behind the breastbone, rising to the throat | Pressure, tightness, heaviness, crushing |
| Pain spreading? | Stays in chest/throat | May spread to jaw, neck, arms (especially left), back |
| Shortness of breath? | Not typical | Common — a key warning sign |
| Cold sweats? | Not associated | Common alongside chest pain |
| Sour taste / belching? | Common | Not associated |
| Duration | Minutes to hours; eases with antacids | Persistent; unaffected by rest or antacids |
The key rule: heartburn is relieved by antacids and worsened by lying down after meals. A heart attack ignores antacids, can strike at any time, and brings breathlessness, sweating, or pain spreading beyond the chest. When in doubt, always treat it as a heart attack.
What a heart attack is — and its symptoms
A heart attack (myocardial infarction) happens when the blood supply to part of the heart muscle is suddenly blocked — usually by a clot forming on a ruptured fatty plaque in a coronary artery. Without prompt treatment to restore flow, heart muscle dies; the faster flow is restored, the better the outcome. Around 100,000 UK hospital admissions each year are for heart attacks.
- Chest pain, tightness or pressure — a heavy weight, squeezing or crushing sensation
- Pain lasting more than a few minutes, or coming and going repeatedly
- Pain spreading to the jaw, neck, arms (especially the left), back or stomach
- Shortness of breath — with or without chest discomfort
- Cold sweats, nausea or vomiting
- Sudden fatigue, light-headedness or dizziness
Atypical presentations: women, older adults and people with diabetes are more likely to have a heart attack without classic chest pain — unusual fatigue, jaw pain or breathlessness alone. Any of these deserve urgent evaluation.
What angina is
Angina is chest pain from reduced blood flow to the heart — the same mechanism as a heart attack but temporary, without permanent muscle damage. Stable angina is predictable: it comes on with exertion or stress and eases with rest or GTN spray. Unstable angina occurs at rest, is unpredictable, and signals a heart attack may be imminent — it is a medical emergency. Because angina can burn and tighten, it is sometimes mistaken for heartburn; the giveaways are its link to exertion and its indifference to antacids.
What heartburn is
Heartburn is the burning caused by acid reflux — stomach acid escaping upwards into the oesophagus. Despite the name, it has nothing to do with the heart: the stomach’s powerful acid meets the oesophagus’s unprotected lining, and the result is pain rising behind the breastbone, a sour taste, belching, and symptoms that worsen after meals or on lying down — and ease with antacids. Heartburn striking twice a week or more is classified as GORD and deserves proper treatment: see our GORD guide.
Can anxiety cause chest pain like heartburn?
Yes — and this three-way confusion (anxiety, heartburn, heart) is one of the most common chest-pain stories in practice. Anxiety and panic produce real physical symptoms: chest tightness, burning sensations, a racing or pounding heart, and over-breathing that itself causes chest discomfort and tingling fingers. Two honest observations help. First, anxiety genuinely amplifies reflux — stress makes the oesophagus more sensitive to acid, so the two conditions feed each other (covered in our everyday triggers guide). Second, the fear of heart disease is part of the loop: each episode of chest discomfort triggers alarm, which worsens the symptoms. The way out is sequence: red-flag pattern → 999, always; recurring non-red-flag symptoms → get the heart formally assessed once, then treat the reflux and the anxiety with a clear conscience rather than re-fearing every episode.
Other causes of burning chest pain
Oesophageal spasm
Uncoordinated contractions of the food pipe cause gripping central chest pain that can mimic cardiac pain closely — sometimes even easing with GTN. Often triggered by very hot or cold drinks. Needs cardiac exclusion first, then gastroenterology assessment.
Costochondritis
Inflammation of the joints between ribs and breastbone. The clue: the chest wall is tender to press, and pain sharpens with movement or deep breaths — neither is true of cardiac pain or heartburn. Settles with time and anti-inflammatories.
Gallstones
Biliary colic causes severe pain under the right ribs or centre-upper abdomen, classically after fatty meals, lasting one to several hours — often mislabelled “terrible indigestion”. Recurrent attacks deserve an ultrasound via your GP.
Trapped wind
Swallowed air and gas can cause sharp chest pressure that shifts with position and eases with belching — briefly alarming, quickly resolving, and unaccompanied by breathlessness or sweating.
When to call 999
- Chest pain, tightness or pressure lasting more than a few minutes
- Chest discomfort that comes and goes over several minutes
- Pain spreading to your jaw, neck, arms or back
- Shortness of breath alongside chest discomfort
- Cold sweats, pallor or clammy skin
- Sudden nausea, vomiting, faintness or loss of consciousness with chest symptoms
- Any chest pain you cannot explain and that worries you
Do not wait. If there is any possibility your chest pain is cardiac, call 999 now. Do not drive yourself to hospital, and do not wait to see if it passes — time-critical treatments like stenting work best within the first 90 minutes. Every minute matters.
When to see a doctor about heartburn
Once the heart is not in question, heartburn has its own thresholds: see a clinician if it strikes twice a week or more, fails to improve after two weeks of over-the-counter treatment, or comes with difficulty swallowing, unexplained weight loss, persistent vomiting — or if you are over 55 with new or changing symptoms. These need assessment rather than escalating self-medication.
Treating heartburn once the heart is ruled out
The ladder is simple. Lifestyle changes — smaller meals, a 3-hour gap before bed, fewer trigger foods — help everyone. Antacids and alginates (Gaviscon, Rennie) handle occasional episodes in minutes. For frequent heartburn, a once-daily PPI such as omeprazole or lansoprazole prevents the acid at its source — the fast-relief playbook is in how to get rid of heartburn.
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How do I tell the difference between a heart attack and heartburn?
Heartburn typically follows meals, worsens lying down and eases with antacids. A heart attack can strike at any time, is not touched by antacids, and brings company: breathlessness, cold sweats, nausea, or pain spreading to the jaw, neck or arms. The rule that keeps people safe: if in doubt, treat it as a heart attack and call 999.
Can heartburn cause pain in your left arm?
Classic heartburn stays behind the breastbone and rises towards the throat — pain spreading into the left arm is not a reflux pattern and should be treated as potentially cardiac. Call 999 for chest pain that spreads to the arm, neck, jaw or back, particularly with breathlessness or sweating.
Can trapped wind feel like a heart attack?
It can feel alarming — trapped wind and swallowed air can cause sharp chest pressure that eases with belching or a change of position. That relief with belching, and the absence of breathlessness, sweating or pain spreading to the arm or jaw, points away from the heart. But new, unexplained chest pain should never be self-diagnosed as wind: when unsure, get it assessed.
Can anxiety cause chest pain like heartburn?
Yes — anxiety and panic can produce chest tightness, burning sensations and a racing heart that closely mimic both heartburn and cardiac pain, and the fear those symptoms cause then feeds the anxiety. Clues pointing to anxiety include onset with stress, over-breathing and tingling fingers. The safe sequence: rule out the heart first (999 for the red-flag pattern), then address the reflux and the anxiety, which often overlap.
How long does heartburn last?
From a few minutes to a couple of hours, typically easing with an antacid or as the stomach empties. Cardiac pain, by contrast, tends to persist beyond a few minutes regardless of antacids and rest — one more reason ongoing chest pain is a 999 call, not a wait-and-see.
Can angina feel like heartburn?
Yes — angina can cause a burning or tight chest sensation that resembles heartburn. Unlike heartburn it is typically brought on by exertion or stress, eases with rest or GTN spray, and does not respond to antacids. New or unexplained chest symptoms deserve prompt medical assessment, as angina is a warning sign of cardiac risk.
Treatment from Access Doctor
For heartburn that keeps returning once cardiac causes are excluded, Access Doctor’s pharmacist independent prescribers can prescribe effective preventive treatment following a short online consultation.
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Omeprazole
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Lansoprazole
A fast-acting alternative PPI, including an orodispersible option.
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Esomeprazole
A stronger option for severe or persistent reflux symptoms.
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Start consultation →References
- National Institute for Health and Care Excellence. Acute coronary syndromes: diagnosis and management (NG185). 2020. nice.org.uk
- National Institute for Health and Care Excellence. Gastro-oesophageal reflux disease and dyspepsia in adults (CG184). Updated 2023. nice.org.uk
- NHS. Heart attack. 2023. nhs.uk
- British Heart Foundation. Heart attack symptoms. bhf.org.uk
- Swap CJ, Nagurney JT. Value and limitations of chest pain history in the evaluation of patients with suspected acute coronary syndromes. JAMA. 2005. pubmed.ncbi.nlm.nih.gov
Medical disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional for diagnosis and treatment. In a medical emergency, call 999.