You’ve just finished a not-so-lovely dinner of hamburgers and French fries when the chest pain strikes. How do you know if the chest pain is a symptom of a heart attack — or indigestion? Do you know the signs of heartburn versus the signs of heart attack?

Need to Know

Heart attack can be sudden and dramatic. When the heart comes to a screeching halt, it is called sudden cardiac arrest.

But most heart attacks are far more subtle. In fact, many people have experienced small heart attacks without even realizing it. Always call for an ambulance if you have chest pain that lasts for more than a few minutes or any other warning signs of heart attack such as:

Crushing chest pain that spreads to the arms, neck or shoulders
Shortness of breath
A cold sweat
Feeling faint

Chest pain is always an indication that something is awry, but it can be tricky to figure out whether it’s angina, heart attack, heartburn, or another gastrointestinal problem. That’s partly because nerves in the stomach and heart are far less specific than nerves in other parts of the body.

Many of the nerves throughout the gastrointestinal track and the heart send the same signal to the brain: chest pain. If someone steps on your toe, you can immediately tell which toe they stomped on. Not so in the heart and stomach. Injuries to the heart, lungs, pancreas, esophagus, or stomach may all cause similar feelings of pain that seems to originate from the chest.

Those mixed up nerves mean that heartburn can mimic the classic symptoms of heart attack, especially chest pain – and vice versa. More than one heart attack victim has reached for an antacid and sworn she’d be okay in the morning, never to reawaken. And many a person has gone screeching off to the hospital in an ambulance, only to come away with a diagnosis of acid reflux.

Need to Know

Never ignore persistent heartburn. If heartburn recurs frequently or becomes constant, be sure to schedule a visit with your doctor.

Persistent heartburn may suggest you have a serious condition called gastrointestinal reflux disease (GERD). In people with GERD, acid is released from the stomach into the lower end of the esophagus. Unchecked, the acid can damage the esophagus, leading to long-term discomfort and even cancer.

So how do you know what to do when you experience chest pain? It might be difficult – or even impossible – to tell what’s going on in your innards without a trip to the emergency room. However, answering the following nine questions can help you decide whether it’s time to call for an ambulance or to take an antacid:

Question 1: What is the chest pain like?

A heart attack occurs when blood flow to the heart is cut off for some reason, usually because of a clot or build up of plaque in the blood vessels that feed the heart. The pain that occurs when heart tissue does not get enough oxygen (called ischemia) is called angina. When heart tissue begins to become damaged or die, it is called a heart attack or myocardial infarction (MI).

People with heart attack often describe the painful sensation as “dull” and characterized by “crushing pressure” or a “squeezing sensation.” The person may say, “It feels like there’s an elephant standing on my chest.”

The pain of heartburn, in contrast, stems from the acidic contents of the stomach traveling back up into the esophagus. Heartburn-related pain is usually sharp and stabbing, without a feeling of pressure.

Need to Know

Women, the elderly, and people with diabetes are less likely to feel the classic signs of heart attack, especially crushing chest pain. They may experience a “silent” heart attack, in which no clear symptoms of heart attack are present. Some may experience other signs, such as jaw pain or cold sweats, while others may feel generally lousy but have few to none of the classic symptoms.

Question 2: Where is the pain located? In people who are having a heart attack, pain may radiate to the shoulder, one or both arms, back, neck, jaw, or stomach. It may be hard to pinpoint the pain. In heartburn, pain generally begins in the lower chest or upper abdomen and may reach to the lower throat.

Question 3: Does anything make the pain and other symptoms better or worse?

Chest pain from angina is usually relieved by rest or nitroglycerin, a prescription drug that relaxes blood vessels, allowing blood to pass through once again.

Once ischemia has progressed to heart attack, there’s little that can make the pain go away. People with a history of heart problems may find that their regular medications (e.g. nitroglycerin) don’t work. Antacids do nothing to stop the pain and other symptoms (although some people may experience a temporary placebo effect after taking an antacid).

Pain from heartburn may worsen if the person lies down or bends over. The discomfort may get better if the person drinks cool water. Antacids can help notably

Question 4: How long does the pain and discomfort last?

Angina usually causes pain that lasts only five to fifteen minutes. Pain from heart attack generally lasts for 20 minutes or more, and it may go away and come back. In contrast, gastrointestinal pain can last for hours or days.

Question 5: Is the person nauseous?

Nausea is a classic sign of heart attack. Somewhat ironically, nausea is less common in heartburn. The person experiencing heart attack may become extremely nauseous and begin vomiting; the person experiencing heartburn may say that it feels like food is coming back into his mouth and complain of a bitter or acidic taste in the back of the throat.

Question 6: Is the person having difficulty breathing?

Heart attack victims often feel short of breath. The person may say, “I can’t catch my breath,” even though his lungs are fine. In contrast, the person with heartburn rarely complains of a need for air, although the person may experience pain upon inhalation and may take smaller breaths. But the person doesn’t generally gasp for air or complain that he can’t get enough air.

Question 7: Is the person experiencing a cold sweat, lightheadedness, or dizziness?

Heart attack symptoms include a cold sweat, lightheadedness, and dizziness. The skin may turn pale, blue, or gray. Heartburn is rarely accompanied by a cold sweat, lightheadedness, or dizziness . Skin usually remains pink, warm, and dry.

Question 8: When does the pain occur?

Pain from a heart attack may occur at any time. Heart attacks frequently occur after exercise, during sleep, in cold weather, or after any sort of extra stressful event.

In heartburn, pain occurs most often after a large, spicy, or fatty meal (Just to confuse things, though, heart attack symptoms may crop up after a big meal, when blood is diverted from the heart to the digestive system to help out). Pain can also occur when the stomach is empty, which causes the stomach to secrete additional acid.

Question 9: What is the person’s mental state?

Anxiety, denial, and cloudy judgment are some of the most common and least well-known signs of heart attack.

The brain needs a constant supply of oxygen and glucose to function, and if the heart isn’t doing its job, the brain isn’t getting enough of either. When the heart stops pumping enough oxygen-rich blood, the brain senses oxygen levels dropping and goes into overdrive to protect itself. As a result, the person may feel anxious, have difficulty thinking clearly, and above all, deny that anything is wrong.

The heart attack victim may appear anxious or even angry, belligerent, or combative. The person may deny that anything is wrong and grow angry if someone calls for emergency help — or the person may have what’s called “an impending sense of doom.” She may say, “I’m going to die.” The person may become extremely anxious and disoriented.

Heartburn can also be accompanied by cloudy judgment and anxiety. Generally, though, heartburn doesn’t lead to the same level of anxiety and clouded thinking as heart attack. The person may be distracted by the pain but is generally able to function at their usual mental capacity.