Chest pain is very common among people visiting the emergency department or their GPs. It can be a source of anxiety for both patients and doctors as the cause could vary from serious conditions, such as heart attack, to less serious but yet distressing conditions, such as indigestion. Many people who have had a heart attack may seek help due to the persistent nature of the disease and profound long-lasting chest pains. However, people with angina experience more short-lasting chest pains and, therefore, may put off seeking help mistaking them for a bad indigestion. The emergency rooms would be overcrowded if every person with an indigestion thought they had angina or a heart attack. On the other hand, not seeking help after experiencing chest pain related to angina could lead to devastating consequences. It is, therefore, necessary to establish if there is a link between angina and indigestion.
Both angina and indigestion manifest in chest pain. The difference lies in the location, type, and duration of pain. Angina is mainly characterised by pain across the chest, although it can also happen in the jaw, neck, or arms.1 The pain caused by indigestion is usually in the centre of the chest or upper belly.
Most people with angina-type pain describe it as a feeling of pressure or heaviness on the chest. Whereas, the pain of indigestion is sharp and burning, hence it is also called heartburn.
While angina pain lasts a few minutes, usually less than 10 minutes, the pain caused by indigestion could last from minutes to hours. If angina pain is lasting more than 10 minutes, you need to call the ambulance as this could be unstable angina or a heart attack.
Difference between heartburn and heart attack
Every organ has a pipe that carries blood containing oxygen to it. These are called arteries. The pipes that carry oxygen to the heart muscles are called coronary arteries. If there is high cholesterol concentration in the blood or the blood walls are damaged as a result of smoking, diabetes, or high blood pressure, these pipes can get clogged up by fatty mounds called plaques. People with narrowed or blocked coronary arteries are said to have coronary artery disease. When the pipe is partially blocked or narrowed, some blood can still get to the heart muscle but not enough to supply the required amount of oxygen. This results in angina pain in that part of the heart.
There are two forms of angina: stable angina and unstable angina. In stable angina, chest pain is usually brought on by exercise and is short-lived because the artery is not severely blocked. In unstable angina, pain could come on at rest and lasts longer than 10 minutes because the coronary artery or its branch is almost completely blocked. On the other hand, a heart attack occurs when blood cannot get through due to a complete blockage of the pipe by a clot, hence the part of the heart muscle that is not receiving adequate amounts of blood dies off. This is why the pain of heart attack is persistent unlike angina which comes and goes.
Contrastingly, heartburn has nothing to do with your heart health. Rather, it is related to the digestive system. The stomach contains acid which helps in the digestion of food. Heartburn occurs when the content of the stomach flows back into the food pipe (reflux). The irritation of the wall of the food pipe due to the acidic nature of these contents causes a burning sensation in the middle of the chest.
While heart attack may present with other symptoms, such as sweating, nausea, and shortness of breath, heartburn presents other symptoms, such as metallic taste in mouth and nausea.2
Does angina cause indigestion?
Coronary artery disease may cause pain similar to indigestion and vice versa. Studies have shown that those who have coronary artery disease are more likely to experience heartburn. A randomised controlled trial3 testing the effect of giving Esomeprazole (a pill which neutralises stomach acid) to coronary artery disease sufferers found out that it significantly reduced the occurrence of chest pain and hospitalisations among this group compared to the placebo group.3 This suggests that some presentations of chest pain by patients with coronary artery disease are in fact related to indigestion.
Research has also shown that heartburn has similar risk factors to those of coronary artery disease, such as obesity, smoking, hypertension and diabetes.3, 4 Hence, it is not uncommon for these two conditions to co-exist or for one to precede the other.
If you see a doctor about the pain in the chest, they will ask you a few questions, such as when it started, where the pain is, how long it has been, and the type of pain. Your doctor might want to examine you to check your heart rate, blood pressure, listen to your chest, or feel your abdomen. Diagnosis of angina or indigestion is typically made by examining your medical history and performing health screenings. If your doctor suspects you might have angina, you may be referred to a heart specialist to undergo electrocardiogram (ECG) during exercise, and an angiogram to check the state of your coronary arteries. You may not need any further screenings for indigestion unless you have other complications or are unresponsive to treatment.
Angina can be treated by spray, tablets, or surgery. Stable angina usually responds to glyceryl trinitrate (GNT) spray, which helps relax the coronary arteries so that blood can flow easily and more oxygen can get to the heart muscle.
If you have suffered a heart attack or have had a heart surgery, you can access cardiac rehabilitation programmes through your hospital. This service aims to assist you with a quick recovery through education, exercise, and other forms of social support.6
There are things you can do to reduce the frequency of heartburn. These include raising the head of your bed when sleeping and avoiding eating late or just before bed. A healthy diet, exercise, treating high blood pressure, diabetes and high cholesterol, and stopping smoking can also reduce the risk factors of developing angina.
Angina and indigestion cause similar chest pain and can be easily confused one for the other. They could also co-exist. If you have pain in your chest lasting longer than 10 minutes, please see your doctor.
- Ford TJ, Berry CAngina: contemporary diagnosis and management Heart 2020;106:387-398.
- Heart attack - NHS (www.nhs.uk)
- Liuzzo J, Ambrose J, Das S, Devoe M, Korabathina R, Agarwal S, Deshmukh S, Coppola J. Prospective, randomised, placebo-controlled evaluation of esomeprazole in coronary artery disease patients. EPAC: esomeprazole prevention of atypical chest pains. J Invasive Cardiol. 2011 Jun;23(6):222-6. PMID: 21646646.
- MOKI, F., KUSANO, M., MIZUIDE, M., SHIMOYAMA, Y., KAWAMURA, O., TAKAGI, H., IMAI, T. and MORI, M. (2007), Association between reflux oesophagitis and features of the metabolic syndrome in Japan. Alimentary Pharmacology & Therapeutics, 26: 1069-1075. https://doi.org/10.1111/j.1365-2036.2007.03454.x
- Wu JC, Mui LM, Cheung CM, Chan Y, Sung JJ. Obesity is associated with increased transient lower esophageal sphincter relaxation. Gastroenterology. 2007 Mar;132(3):883-9. doi: 10.1053/j.gastro.2006.12.032. Epub 2006 Dec 19. PMID: 17324403.
- Coronary heart disease - Recovery - NHS (www.nhs.uk)