Chest pain is one of the most alarming symptoms a person can experience. Sometimes it’s nothing more than heartburn after a heavy or spicy meal. Other times, it could be the sign of something far more serious — a heart attack. Because the sensations can overlap, knowing how to distinguish the two is crucial for your safety and peace of mind.

Heartburn occurs when stomach acid moves upward into the esophagus, producing a burning sensation in the chest. A heart attack, on the other hand, happens when blood flow to the heart muscle is blocked, leading to pressure, pain, and potentially life-threatening complications.

While not all chest pain signals an emergency, ignoring the warning signs of a heart attack can be dangerous. Here’s what you need to know about how these two conditions differ, when to seek immediate care, and why it’s always better to be cautious.

How To Tell The Difference Between Heartburn And Heart Attack

Chest pain from heartburn often feels like a sharp, burning discomfort just behind the breastbone. It typically flares up after eating certain foods — especially high-fat, spicy, or acidic meals — and may worsen when you lie down or bend forward.

Chest pain from a heart attack is usually described as tightness, heaviness, or squeezing. It may feel as if someone is applying strong pressure to your chest. This pain often intensifies with physical exertion or severe emotional stress and may not improve with position changes.

Key differences to notice:

  • Heartburn is linked to meals and body position.

  • Heart attack pain is more likely to radiate to the neck, jaw, arms, or back.

  • Heartburn usually improves with antacids. Heart attack pain persists or worsens despite rest.

If you’re uncertain, treat the pain as heart-related until proven otherwise.

Other Symptoms That Point To A Heart Attack

A heart attack rarely presents with chest pain alone. Other accompanying signs include:

  • Shortness of breath

  • Dizziness or fainting

  • Nausea or vomiting

  • Sweating or cold clamminess

  • Irregular pulse or palpitations

  • Pain radiating to the arms, back, or jaw

People with risk factors such as diabetes, obesity, high cholesterol, smoking, or a family history of heart disease should be especially alert. Age also increases risk — the older you are, the more likely chest pain is heart-related.

Duration And Timing Of Pain

The length of time chest discomfort lasts can also help distinguish the cause.

  • Heartburn pain may last minutes to hours but is closely tied to eating and posture. It often appears shortly after meals.

  • Angina (chest pain from limited blood flow) usually comes on with exertion or stress, lasts a few minutes, and improves with rest.

  • Heart attack pain can last much longer — hours if untreated — and may come in waves of increasing intensity.

Any chest pain that doesn’t improve within a few minutes of rest should be considered a medical emergency.

Pain After Eating Certain Foods

Heartburn often follows meals, especially those high in fat, spice, or acidity. Symptoms may include:

  • A sour taste in the mouth

  • Pain worsening when lying flat

  • Discomfort that improves with antacids

However, food can sometimes trigger heart-related pain as well. After a large meal, blood is diverted to aid digestion, potentially reducing blood flow to the heart in people with underlying disease. That’s why it’s risky to dismiss chest pain after eating as “just heartburn.”

Symptoms In Women And Older Adults

While chest pain remains the most common symptom of heart attack across all groups, women and older adults often experience less typical signs.

  • Women may feel unusual fatigue, nausea, or general malaise instead of crushing chest pressure.

  • Older adults may present with faintness, breathlessness, or vague discomfort rather than sharp chest pain.

These atypical symptoms sometimes delay diagnosis, increasing the risk of complications.

Why Heartburn And Heart Attack Feel Similar

Both the esophagus and the heart are located in the chest, and they share similar nerve pathways. This overlap can confuse the brain, making it hard to pinpoint the origin of pain.

Conditions such as gastroesophageal reflux disease (GERD), ulcers, or other gastrointestinal issues may produce pain that mimics angina. Conversely, true heart pain can sometimes feel like burning. This is why chest pain is taken so seriously in medical settings — it’s simply too risky to assume it’s benign.

Non-Cardiac Chest Pain

Not all chest discomfort stems from the heart. Millions of people in the U.S. experience non-cardiac chest pain (NCCP), with GERD being the most common culprit. Other causes include esophageal spasms, musculoskeletal pain, or lung conditions.

Still, distinguishing between NCCP and cardiac chest pain requires medical evaluation. Because nerve pathways in the chest are less precise, you may only sense “pain in the chest” without knowing whether it originates from the heart, lungs, or digestive tract.

Treatment Approaches

If it’s heartburn:

  • Over-the-counter antacids may neutralize acid and provide quick relief.

  • Lifestyle changes such as avoiding trigger foods, eating smaller meals, and not lying down soon after eating help prevent recurrence.

If it’s heart-related:

  • Nitroglycerin is often prescribed for angina to widen blood vessels and improve blood flow.

  • Aspirin is sometimes recommended at the onset of suspected heart attack symptoms to help prevent further clotting — but only if you do not have a known history of stomach ulcers.

  • Emergency care is essential, as quick treatment can minimize heart damage.

Remember: “Time is muscle.” The longer the heart muscle is deprived of blood, the greater the risk of permanent injury.

When To Seek Medical Care

Always err on the side of caution with chest pain. Seek immediate emergency care if you experience:

  • Chest tightness or crushing pressure

  • Fainting or severe weakness

  • Profuse sweating or paleness

  • Pain radiating beyond the chest

See your doctor promptly for new, recurring, or unexplained chest pain, even if mild. Routine check-ups are especially important for individuals with diabetes, high blood pressure, or high cholesterol. These conditions significantly increase the risk of heart disease.

Key Takeaway

Heartburn and heart attack pain can feel strikingly similar, but the stakes are very different. Heartburn is often tied to meals and improves with antacids or positional changes. A heart attack is more likely to cause persistent, pressure-like pain that may spread to other parts of the body and come with shortness of breath, dizziness, or sweating.

If you’re unsure, always seek medical help immediately. It’s better to spend a few hours in an emergency room ruling out a heart attack than to risk permanent heart damage by waiting.