Have you ever experienced a tight squeezing pain in your chest and worried that it might be a problem with your heart? While this may be true, there is also a chance it could be caused by GERD or otherwise referred to as gastroesophageal reflux disease. This article will discuss the difference between chest pain from angina and chest pain from GERD and when you might need to dial 999.
What is Angina?
Angina can be described as chest pain caused by reduced blood flow to the heart muscles. It is usually not life-threatening but can signify a severe cardiac problem such as coronary heart disease. Angina is diagnosed by your doctor based on your symptoms and medical history and can be managed by taking certain medications and making simple lifestyle changes.1
Types of Angina
There are several different types of angina, the two most common being stable and unstable angina. Some people may develop unstable angina after having stable angina.1
This is the most common variation of angina. Episodes of chest pain have an identifiable trigger and stop within a few minutes of rest. Some potential triggers may be stress or exercise.
This type of angina is less common and more serious. The attacks are more unpredictable and can sometimes occur without an identifiable trigger. They may also be harder to control and continue despite resting.
Some other types of angina include vasospastic angina, which is very rare and occurs during the night when you're resting. This happens because coronary artery blood supply is restricted.
Another variation of angina is microvascular angina. This is usually experienced when you are under some sort of physical pressure. Such as when you are exercising or feeling stressed or anxious.
Signs and Symptoms
Angina can feel like a pain or discomfort in your chest, and is often described as a pressure, tightness or squeezing sensation. Although the pain is typically localised to your chest, angina may also be felt in your neck, jaw, arms, shoulders, back and stomach.2 Other symptoms of angina may include:
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The symptoms of angina should stop within a few minutes. Panic attacks and anxiety can sometimes cause chest pain, which is sometimes confused with angina. However, it is not caused by a problem with blood flow to the heart.
Causes and Risk Factors
Angina is most commonly caused by coronary heart disease, where narrowing of the blood vessels supplying blood to the heart occurs due to plaque buildup. This results in reduced blood flow to the heart, which can cause angina symptoms.
There are several factors that may trigger angina, including:
- Emotional stress and anxiety
- Cold weather
- Eating a meal
There is a range of different risk factors that can increase your chance of developing coronary heart disease and angina. They include:
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Your risk also increases once you reach the age of 45 in men and 55 in women.
Sometimes eating a meal can trigger angina chest pain. This means that angina is often confused with indigestion or acid reflux.
What is GERD?
Gastroesophageal reflux disease, or GERD, is chronic acid reflux and occurs when stomach acid frequently flows into your oesophagus. This can cause irritation and discomfort. Most people experience acid reflux from time to time, but GERD is acid reflux that occurs multiple times throughout the week.
GERD can often be managed with common over-the-counter medications and specific lifestyle changes. However, some cases require more potent medications or even surgery to control the discomfort associated with GERD symptoms.
Signs and Symptoms
Some common symptoms of GERD include:
- Heartburn, is a burning sensation in your chest which usually occurs after eating a meal and is often worse at night.
- Chest pain
- Difficulty swallowing
- Feeling like there is a lump in your throat
- Regurgitation of food
You may also frequently experience an unpleasant or sour taste in your mouth caused by stomach acid.
Some less common symptoms you may also have are:
- A cough or recurring hiccups
- A hoarse voice
- Bad breath
Non-Cardiac Chest Pain
Non-cardiac chest pain (NCCP) is chest pain that resembles angina but is not caused by a problem with your heart. Causes of NCCP can be grouped into oesophageal and non-oesophageal, mainly caused by problems with your oesophagus. Most often, NCCP is caused by GERD but is also associated with other health problems such as anxiety and depression.3
If you are experiencing frequent chest pain and your healthcare provider rules out a heart problem, it is likely that you will be diagnosed with NCCP and will likely be referred to a gastroenterologist to help treat the root cause of the problem.
Location of Pain
NCCP associated with GERD is typically located in your chest, behind your breastbone and near your heart. Like angina, this chest pain is described as a squeezing sensation or tightness. You may feel this pain across your chest, on the left, right, or middle. Sometimes NCCP can radiate to the back of your body, neck, and arms. 3 Because the location and sensation of chest pain caused by GERD is similar to angina. It is easy to mistake one for the other.
Causes and Risk Factors
GERD occurs when the ring of muscle between your oesophagus and stomach is weak or relaxes when it shouldn't, allowing stomach acid to flow back up the oesophagus.
Some factors known to exacerbate chronic acid reflux are:
- Particular food and drinks, such as alcohol, chocolate, coffee, tomatoes, and other fatty or spicy foods
- Being overweight
- Stress and anxiety
- Some medicines, typically NSAIDs
Some cases of GERD are believed to be caused by a hiatal hernia, which may weaken the ring of muscle in your oesophagus and increase your chance of gastroesophageal reflux.
Eating large meals or eating too soon before going to bed may make GERD symptoms worse.
How to Tell if it’s GERD or Angina
Often it is difficult to tell the difference between the pain experienced from angina and GERD. The location and feel of both angina and NCCP are very similar and hard to differentiate. If you are experiencing frequent chest pain, you should book an appointment with your healthcare provider, who will be able to discuss the possible cause of your pain, and refer you to a specialist to determine the underlying source.
Is it Angina or a Heart Attack? When to Dial 999
It is essential to recognise the difference between the symptoms of angina and the symptoms of a heart attack.
If you have not been diagnosed with angina and have chest pain that stops after a few minutes of rest, it is advisable to get an urgent appointment with your healthcare provider. Your doctor will check if it may be a heart problem and can refer you for further specialist tests.
If you experience chest pain that does not stop after a few minutes of rest, this is when you should dial 999 and seek immediate help, as it may be a heart attack.
If your angina symptoms appear to worsen, occur more frequently, or change in any way, you should book an appointment with your doctor to discuss why this may be.
How to Spot the Difference
Chest pain caused by a heart attack is usually a severe feeling of pressure, heaviness, tightness or squeezing across your chest. However, it can also be mild and feel similar to angina. It is important to remember that the symptoms of angina can be managed with medication, but this will not affect the symptoms of a heart attack.
If you have angina, you may be prescribed a medication called glyceryl trinitrate, which should improve your chest pain within 5 minutes. If the first dose of this medication does not work, you can take two subsequent doses at 5-minute intervals. If the pain persists after three doses of glyceryl trinitrate, over 15 minutes, you should call 999.4
In conclusion, chest pain can be caused by various health problems. Determining whether your chest pain is angina, caused by a problem with your cardiovascular system, or a type of non-cardiac chest pain such as a symptom of GERD, is vital to ensure you are receiving the proper treatment and support. If you are experiencing frequent pain in your chest, you should book an urgent appointment with your healthcare provider to determine the source of your pain and get the help you need to manage the problem.
- British Heart Foundation: Angina - Causes, symptoms & treatments. https://www.bhf.org.uk/informationsupport/conditions/angina (accessed on 28/06/22)
- NHS: Angina. https://www.nhs.uk/conditions/angina/ (accessed on 28/06/22)
- American College of Gastroenterology: Non-cardiac Chest Pain. https://gi.org/topics/non-cardiac-chest-pain/ (accessed on 28/06/22)
- NHS: Heart Attack. https://www.nhs.uk/conditions/heart-attack/symptoms/ (accessed on 28/09/22)