Is this burning from the stomach or the heart?

A question with no quick answer

You wake in the middle of the night with burning behind your breastbone. Most people’s first thought is: “It must have been a heavy dinner.” Sometimes that is right. But the same feeling can come from the heart, and from the feeling alone nobody can tell the difference with certainty, not you and not even a doctor. So the key rule of this article is one sentence:

Do not assume chest pain or pressure is digestive.

Why do they feel so alike?

Reflux burning starts in the middle of the chest, behind the breastbone, and sometimes rises to the throat. NIDDK describes the feeling this way and says chest pain is itself one of the symptoms of reflux. MedlinePlus, in its list of causes of chest pain, puts heartburn and oesophageal disease next to heart attack and angina, and alongside them panic attacks, sore muscles and lung disease.

On the other side, the NHS says a heart attack can also feel like indigestion: burning in the chest, a feeling of fullness and bloating. So two different causes can look the same. That is why “I know it’s my stomach” is not a sentence to rely on.

Signs that mean you should take a heart cause seriously

The NHS and MedlinePlus list signs that you should get to a doctor immediately. If chest pain comes with any of these, do not wait:

• Pressure, tightness or crushing pain in the chest
• Pain or heaviness that spreads to the arm, neck or jaw
• Shortness of breath
• Cold sweat
• Nausea or feeling unwell
• Dizziness or paleness, or a blue-grey colour of the skin
• Pain that does not stop

When explaining indigestion, NIDDK also counts chest pain, and pain that spreads to the jaw, neck and arm, among the signs that should be shown to a doctor “right away.” So if you have chest pain, do not count it as indigestion yourself.

What to do if you have any of these

1. Call 115 (Iran’s emergency number). Do not wait to see whether it goes away on its own.
2. Do not drive yourself. The NHS is explicit that you should not drive yourself to the emergency department. Ask someone to take you or call an ambulance.
3. Sit down and rest, and have your list of medicines ready.
4. Do not think you are a bother. If it turns out not to be the heart, that is better than it having been the heart and you having waited.

What medicine to take for chest pain is for the emergency service to say, not an article.

So what about digestive burning?

Yes, most chest burning that comes after meals and has had a steady pattern for a long time is digestive. NIDDK describes reflux as burning behind the breastbone and stomach contents coming back up to the throat or mouth with a sour taste. But even for someone who has reflux:

• If the pain is new, or comes with sweating, shortness of breath, nausea and pain in the arm and jaw, do not call it “my usual reflux.”
• If the burning or pressure comes on or gets worse with walking or effort, or has suddenly become heavier than usual, do not put it down to reflux. Call 115, because this pattern can come from the heart. If it has only become more frequent or longer-lasting, with none of these signs, see a doctor within the next few days.
• If you have a heart history or are worried about one, tell your doctor. Checking the heart is separate from checking the stomach, and one does not rule out the other.

Digestive burning that needs a visit

Most burning is not an emergency, but you do not have to put up with it. The NHS says to see a doctor if changes to habits and pharmacy medicines have not helped, if you have it most days, or if it comes with food sticking in the throat, repeated nausea or unexplained weight loss. NIDDK also says to see a doctor if it continues despite lifestyle changes and over-the-counter medicines. Signs such as vomiting blood or black tarry stool are also listed by NIDDK as reasons to seek care. See lifestyle measures in the guide to food and daily habits and the list of warning signs in urgent warning signs.

Reflux can be investigated

If you have constant reflux, a gastroenterologist can look into its cause and severity. Not everyone needs an endoscopy; this decision depends on symptoms and history. Talk with a gastroenterologist, and if you have chest pain, the doctor may first want to check the heart. Do not delay that.

Summary

• Chest burning is usually from the stomach, but you cannot be sure from the feeling.
• Do not assume chest pain is digestive.
• If the pain comes with pressure, sweating, shortness of breath, nausea, or pain in the arm, neck and jaw, call 115.
• Do not drive yourself.
• Show a persistent, bothersome burning to a doctor, without anxiety but without delay.