Chest pain after a heavy meal may indicate a heart attack, not just acidity, especially in individuals with heart risk factors.
Chest pain due to a heavy meal is often considered as acidity or indigestion. But chest pain may be one of the first indicators of a heart attack, which can feel very much like acidity. This is just one reason why chest pain should not simply be categorized as “gas” or “acidity” especially among individuals at risk for heart problems. Heart attacks happen due to the blockage of a coronary artery that supplies blood to a portion of the heart muscles, thereby causing lack of oxygen to the muscles. On the other hand, heartburn happens due to the rising up of stomach acid towards the oesophagus. Although the two ailments occur in different parts of the body, their proximity makes them hard to distinguish from each other in terms of sensation.
How heartburn usually feels
Heartburn usually causes burning behind the breastbone. It can rise up to the throat and is associated with a sour or bitter taste, regurgitation, burping, or feeling of fullness. Such complaints often appear after meals, especially after eating a big portion of food, and increase when a person lies down.
Gastroesophageal reflux may also cause chest pain that lacks the burning character of heartburn. That's why using such vague description as “acidity” does not help in determining the cause of complaints. Recurring problems should be medically evaluated and not medicated with OTC drugs again and again without clarifying the reason for that.
What makes heart-related chest discomfort different?
Heart pain is usually characterized by feelings of pain, pressure, squeezing, weight, or tightness and fullness in the center of the chest. These sensations may persist for a few minutes and then stop and reoccur or become increasingly severe. It is noteworthy that the severity of a heart attack need not necessarily be overwhelming.
The sensations may be experienced outside of the chest, in one or both arms, the back, neck, jaw, shoulders, or even in the upper part of the abdomen. Shortness of breath, sweating, nausea, vomiting, lightheadedness, unusual fatigue, and a fast or uneven heartbeat may accompany them. Atypical symptoms, which include unusual fatigue, breathlessness, nausea, and back, shoulder, or jaw discomfort may be experienced by some individuals, mostly women.
Why “it is just acidity” can be dangerous
One of the major challenges facing chest pain is the lack of an effective self-test to tell whether the pain is due to the oesophagus or the heart. Even heart attacks may sometimes be felt as being similar to indigestion, burning, or chest pains.
It becomes very important for one with risk factors like being a smoker, having hypertension, diabetes, high cholesterol, obesity, prior history of heart conditions or history of premature coronary artery disease in the family to suspect a cardiac cause for the pain. Nevertheless, not having any known risk factors doesn't necessarily rule out a cardiac cause of chest pain.
Chest pains cannot also be assumed to be harmless just because they are mild, have happened before or even gotten temporarily better. Heart attacks start gradually and may have fairly unremarkable symptoms. “Silent” heart attacks can be confused with indigestion, tiredness or other common ailments.
When chest discomfort needs emergency attention
The chest pain should always be considered as an emergency when it is first occurring, unknown, persists or is associated with other danger signals. It may be due to pain or pressure that occurs for several minutes, when the symptoms come and go away, pain which extends from the chest to the arm, jaw, back or abdomen, or chest pain along with breathlessness, cold sweat, nausea, dizziness, or weakness.
It is always better to get one such episode investigated and confirm that the heart is alright than to delay treatment of a heart attack since the symptoms are taken for heartburn. The American Heart Association advises people to get emergency help if they have any heart attack symptoms rather than diagnosing at home.
What happens at the hospital?
However, if there are reasons to believe a cardiac origin of the complaint, healthcare providers usually conduct a symptomatic evaluation, history-taking, and some tests including an electrocardiogram (ECG) and testing for biomarkers that can show signs of injury to the myocardium, specifically high-sensitivity cardiac troponin. If needed, additional tests will follow.
That is why timing plays such a crucial role in this case. In case of a heart attack, the patient needs to receive timely care in order to restore blood flow and prevent further injuries to the myocardium. Hence, the delay in receiving care can be dangerous.
If one experiences recurrent burning sensation after meals, one can find medical advice to diagnose reflux and choose the proper treatment. However, in case the burning is new, unprovoked, and accompanied by such symptoms as shortness of breath, sweating, nausea, dizziness, or radiating to other parts of the upper body, one should treat the symptom as potentially cardiac until proven otherwise.
(By Dr. Chirag D, Consultant – Interventional Cardiology, Aster Whitefield Hospitals, Bangalore)