Indigestion or Heart Attack

Overview

What is indigestion?

Indigestion also referred to as dyspepsia or upset stomach, is the pain, discomfort or burning experienced in the upper abdomen. It can also be associated with the feeling of fullness.¹ It is very common and can be treated by medication and lifestyle changes. Usually, it is not a sign of anything serious.²  

Causes 

Indigestion can be caused by health problems, lifestyle issues or medication. 

Health problems

• Ulcers or sores in the small intestine or stomach
• Redness/ swelling/ inflammation in the stomach (gastritis), inflammation in the gallbladder (cholecystitis) or swelling in the pancreas (pancreatitis).
• Acid reflux from the stomach into the oesophagus (Gastroesophageal reflux disease)
• Bacterial infection (Helicobacter pylori) in the stomach
• Gallstones in the gallbladder 
• Gastroparesis (food moving extremely slowly in the stomach, common in people who suffer from diabetes)

Lifestyle issues

• Smoking
• Excess caffeine intake
• Excess alcohol consumption
• Eating in excess or too fast
• Consuming spicy, fatty, greasy, high-fibre food
• Stress

Medication

• Antibiotics 
• Aspirin
• Over-the-counter pain and fever medication (for example, nonsteroidal anti-inflammatory drugs)¹

Symptoms 

The symptoms and severity vary according to the individual and may include

• Feeling of fullness soon after eating
• Pain, burning and discomfort in the upper belly or abdomen region
• Bloating
• Burping, having gas, diarrhoea, upset stomach, nausea, vomiting or loud stomach gurgling
• Often, people with indigestion may experience heartburn caused by stomach acid entering the oesophagus. (Heartburn is a painful burning sensation in the centre of the chest which may radiate into the neck or back)¹

What is a heart attack?

​​Heart attack, or myocardial infarction, occurs when the blood supply to the heart is suddenly blocked, usually due to the presence of a blood clot. Lack of oxygen-rich blood supply to the heart can lead to severe damage which may be life-threatening.

The coronary arteries, which supply blood to the heart muscle, become narrowed from the buildup of fat, cholesterol and other substances. Together, these form a plaque by a slow process called atherosclerosis. When the plaque ruptures, a clot begins to form at the rupture site. This obstructs the flow of blood through the artery to the heart muscle. When a heart muscle has insufficient oxygen and nutrients, damage or death of that part of the heart muscle can occur, called ischemia.³ Heart attack is a medical emergency. Call 999 immediately if you think you or someone you know may be having a heart attack.

Causes 

Heart attacks are caused when the blood supply to the heart is interrupted leading to damage to the heart muscles. If prompt treatment is not provided, irreversible heart muscle damage will occur. If a large part of the heart muscle is damaged, a cardiac arrest occurs, resulting in death.⁴

Coronary Heart Disease is the main cause of a heart attack. Buildup of cholesterol deposits forms plaque leading to clogging of the coronary arteries. Prior to a heart attack, the plaque ruptures, and a blood clot forms at the site of rupture which blocks the blood supply to the heart initiating a heart attack.⁴

Symptoms

Symptoms of a heart attack may vary according to the individual, some may have mild symptoms, others could have more severe symptoms while some may not exhibit any symptoms.

The most common symptom in men and women is chest pain (feeling pressure, heaviness, tightness or squeezing across the heart), while women are more likely to experience other symptoms like shortness of breath, feeling unwell and back or jaw pain. 

Other common symptoms:

• Pain in other parts of the body which can feel as though it is spreading from the chest to arms, jaw, neck, back and stomach.
• Feeling lightheaded/dizzy/fatigued/anxious
• Heartburn or indigestion
• Feeling nauseous or vomiting
• Shortness of breath, coughing or wheezing⁴

Seek medical care immediately if you experience any or a combination of these symptoms to ensure prompt care and prevent permanent damage.

Less common causes:

• Drug misuse (Example stimulants such as cocaine, amphetamines and methamphetamines) may cause narrowing of the coronary arteries restricting blood supply to the heart.
• Lack of oxygen-rich blood supply to the heart due to carbon monoxide poisoning or lung disease may also damage the heart muscles triggering a heart attack.

Differences between the symptoms of indigestion and heart attack 

Does the pain radiate?

Often, it can be difficult to tell the difference between indigestion and heart attack. If you’re not sure whether it’s a heart attack or indigestion and chest pain is persistent, consult a doctor.

Indigestion usually begins as pain or burning in the upper belly and moves into the chest up towards the throat while a heart attack usually causes pain, pressure, tightness or discomfort in the chest which may spread to your arms, neck, jaw or back. 

Diagnosis and treatment

Indigestion

Indigestion is initially diagnosed based on medical history and a physical exam. If required, an upper gastrointestinal endoscopy, laboratory tests (to check for anaemia or other metabolic disorders), urine, blood, breath and stool tests (to check for H. pylori, a bacteria associated with peptic ulcers) or Imaging tests (X-ray or CT scan) can be used to diagnose indigestion.⁵

Most people can treat indigestion at home with diet and lifestyle changes or medication such as antacids. If an underlying health condition is suspected, further tests will be required to determine the cause.⁵

Heart attack

If a heart attack is suspected, it is important that you are immediately admitted to the hospital and an Electrocardiogram (ECG) test is performed within 10 minutes of admission. ECG measures the electrical activity of the heart. It is essential for diagnosing a heart attack and helps determine the type of heart attack which has occurred.⁴ If an ECG does not confirm a heart attack, further investigation is required which includes assessment of symptoms and medical history, physical examinations (measuring blood pressure and monitoring heart rate and rhythm), blood tests (to detect heart damage) or an echocardiogram (to obtain an image of the heart structure).⁶

Immediate emergency treatment is essential to regain blood flow to the heart muscle and prevent permanent heart damage: 

• Coronary angioplasty involves inserting one or more stents to re-open the blocked coronary artery.
• Thrombolysis is given to dissolve the blood clot blocking the coronary artery.
• Coronary bypass surgery to restore blood flow to the heart (using a blood vessel from the leg, arm or chest in the heart to bypass the artery which is blocked).

Complications

Indigestion

Severe indigestion can cause long-term complications with parts of the digestion tract, such as esophageal or stomach passage scarring. 

An esophageal stricture occurs when acid reflux irritates the esophageal lining, which over a long period of time causes scarring. This can eventually cause narrowing and constriction of the oesophagus. This causes difficulty swallowing, chest pain and food may get lodged in the throat.

Pyloric stenosis occurs when stomach acid causes long-term irritation of the digestive tract lining. The pylorus becomes scarred and narrowed causing vomiting and preventing proper food digestion.⁷

Heart attack

Complications from a heart attack can vary from mild to serious.

Arrhythmia - An abnormal heartbeat can develop after a heart attack as a result of muscle damage which disrupts the electrical signals that control the heart.

Heart failure - Occurs when the heart is unable to effectively pump blood around the body due to excessive heart muscle damage. It commonly occurs in the left ventricle of the heart.

Cardiogenic shock - Is very similar to heart failure, but more severe. Extensive damage to the heart muscle prevents the pumping of sufficient blood to maintain normal body function.

Heart rupture - Occurs when the heart muscle, walls or valves rupture. It is relatively uncommon but is extremely serious (1 in 2 people die within 5 days of rupture). Open heart surgery is required to repair the damage.⁴

Other causes of chest pain

There are several conditions which can cause chest pain. It is important to get immediate medical advice to ensure a correct and prompt diagnosis.

• Pericarditis: inflammation of the sac surrounding the heart which can cause a sudden, sharp stabbing pain or a dull ache in the chest. It usually gets worse when one lies down.
• Lung conditions such as pneumonia (lung inflammation due to infection) or pleurisy (inflammation of the membrane surrounding the lung).
• costochondritis : inflammation of sternum cartilage which can cause pain, swelling and tenderness around the ribs.
• Panic attack or anxiety⁸ 

When to consult a doctor

It can be difficult to tell the difference between indigestion and heart attack. If you’re not sure whether it’s a heart attack or indigestion, and chest pain is persistent consult a doctor at the earliest to prompt and correct diagnosis.

Summary

Indigestion is the pain, discomfort or burning experienced in the upper abdomen ​​while a heart attack occurs when the blood supply to the heart is suddenly blocked, usually due to the presence of a blood clot. It is important to seek prompt medical care to obtain prompt diagnosis and treatment to prevent long-term damage.