Heartburn or heart attack?

You've just enjoyed a favorite dinner with an extra-large helping of mashed potatoes and gravy, finished off with a supersized piece of cake a la mode. What comes next on the menu is something that wasn't ordered- the worst case of heartburn and indigestion ever. Or could it be something more serious?

"Sometimes it's impossible to tell the difference between the symptoms of heartburn, angina and heart attack," said Prediman K. Shah, MD, director of the Division of Cardiology and the Atherosclerosis Research Center at CedarsSinai Medical Center. "There are some useful pointers that might help a person know whether they're having a heart attack or not, but when in doubt, check it out."

Knowing if you have any risk factors that might predispose to a heart attack is the first important factor to keep in mind.

"If you smoke, have diabetes, high cholesterol, high blood pressure, are overweight or have a strong family history of heart disease and have any symptom related to the chest or heart, you should be suspicious," said Shah.

Heart attack symptoms may include the sudden onset of tightness, pressure, squeezing, burning or discomfort in the chest, throat, neck or either arm. These symptoms may be accompanied by nausea, vomiting, sweating, shortness of breath or a fainting sensation.

Angina, the most common symptom of coronary heart disease, is chest pain or discomfort that occurs when the heart muscle doesn't get enough blood. The pain, which can also occur in the shoulder, arms, neck, jaw or back, may also feel like indigestion.

"Generally we recommend that if you think you're having a heart attack, call 911," said Shah. "It's the safest thing to do. We tell people to err on the side of caution and overreact instead of under react."

When a heart attack occurs, the blood supply to part of the heart muscle is severely reduced or stopped when one or more of the coronary arteries that supply blood to the heart is blocked. Death or disability can result, depending on how much of the heart muscle is damaged.

There's no way to predict the time of day or circumstances when a heart attack might occur- in the middle of the night, after a heavy meal, during or immediately after sexual activity or after moderate or heavy physical activity.

Sometimes the symptoms of reflux or common heartburn related to indigestion can look like a heart attack. For a person who has had heartburn all their life, if the symptoms they're experiencing are identical to those they've had before and nothing different has occurred, chances are they're experiencing heartburn and not a heart attack.

But if the symptoms are something they've never had before and are accompanied by feeling light-headed or sweating, then they should take the symptoms more seriously- it could signal a heart attack.

There are many types of heart disease that do not produce chest pain yet can be just as lifethreatening as a heart attack. It is essential for those between ages 45 and 50 to start having regular checkups by a physician, especially before beginning a heavy exercise program.

This story is provided by Cedars-Sinai Medical Center.