When Chest Pain Isn't a Heart Attack

When gripping chest pain occurs, the first suspicion is a heart attack. According to the November issue of the Mayo Clinic Health Letter, however, about 30 percent of people who undergo heart artery imaging for a suspected heart attack are not having one.

The next most likely cause? Heartburn.

For about 60 percent of patients with noncardiac chest pain, heartburn is the culprit. Heartburn is often a symptom of gastroesophageal reflux disease (GERD), where digestive acid flows back or refluxes from the stomach into the esophagus. The esophagus and heart are in very close proximity and have a similar nerve supply. As a result, esophageal pain can be confused with the pain of a heart attack. Doctors often have no way to distinguish between esophageal pain and heart pain without testing.

Heartburn typically causes a burning sensation that may be accompanied by a sour taste in the mouth. Some patients with GERD or heartburn experience chest pain that feels very different from the typical burning sensation. Why this chest pain occurs is unclear. One theory is that heartburn may trigger muscle spasms or a fight or flight stress response. Several diagnostic tests are available to hone in on possible causes of chest pain related to the esophagus or heartburn.

Chest pain may result from other health conditions, too. A hiatal hernia, where part of the stomach slides above the diaphragm and into the chest, can cause chest pain. So can gallstones. Injured ribs or sore muscles from chronic conditions such as fibromyalgia can be the source of chest pain. Other possibilities include asthma and some lung problems, anxiety, panic attacks and stress.

When gripping chest pain occurs, seek emergency care. The first task is to rule out heart trouble. A heart attack can be deadly and is the most likely cause of chest pain.