Dear Doctor: How can I tell the difference between heartburn and an actual heart attack?

DEAR DR. ROACH: What is heartburn? Can heartburn feel like a heart attack? -- A.S.Q.

ANSWER: Heartburn is a sensation of discomfort in the upper abdomen or in the lower chest that is burning in quality. Although we often tie heartburn to acid reflux, it’s impossible to be immediately sure of the underlying cause.

People who have had a heart attack generally know what it is if it occurs again, but a person who develops heartburn may not be at all sure what the cause is. I have known many patients, both women and men, who have had heart attacks that they initially attributed to heartburn.

Pain from a heart attack is highly variable. It can be the textbook crushing pain below the sternum (breastbone), but people are more likely to say it feels like pressure or tightness. Nausea and abdomin