Heart attack, heartburn, or something else?

Dear Alice,

I have been going to doctors for two weeks now and no one can find out what's wrong with me. Can you please help me? About two weeks ago, I started to have a terrible burning in my upper chest (the area about my breasts and below my neck). The pain was also in my left arm and back. Obviously, I thought I was having a heart attack and went to the emergency room of my local hospital. After five hours of tests, they said my heart was fine and that this pain could be due to digestive problems. I then consulted a digestion specialist. He did some tests and said I had a large amount of acid in my stomach and when I lay down, which is when I have the most pain, the acid goes up into my esophagus and causes burning. This still did not explain the pain in my arm and back. He said it could also be caused by the acid back-up. He prescribed a medication called Prilosec. He said this was a very strong drug and should work quickly to relieve my pain.

Well it's been ten days since I started taking the drug and no relief in sight. I can hardly sleep because after about 40 minutes, I am awakened by this pain and can only relieve it by sitting up for about an hour. But as I am writing this letter to you, this burning pain is in my back and my left hand is getting numb. Please help. I don't know what to do and I'm afraid it's serious.

Dear concerned,

Mysterious pain that won't quit is apt to make you feel worried or scared, and for good reason. Lasting pain is usually a sign of an underlying health problem, so you're smart to take your discomfort seriously. Anytime you feel really unwell or are unsure what's troubling you, your best bet is to make a beeline to a health care provider. If the pain continues, head back for a second or even a third visit. 

As you know, it can be tricky to tell the difference between heartburn and a heart attack. Since these conditions have similar symptoms, you made a good choice to head to the emergency room when you first experienced strong chest pain. Also known as acid reflux, heartburn occurs when the ring of muscles separating your esophagus from you stomach loosens, allowing digestive acid to back up into the esophagus. Normally, this muscle valve only opens when you swallow, but overeating, lying down too soon after a meal, or pressure from being overweight can cause the muscles to loosen at the wrong time. Rising stomach acid can leave a sour taste in your mouth and cause a burning sensation in your upper abdomen or neck — similar to the chest pains of a heart attack. For more background about heartburn and heart attack, check out the related Q&As.

Since the heartburn medication hasn't given you any relief, it's possible that another condition is causing your chest pain. For example, gallstones or a gallbladder attack can trigger pain in the chest, shoulder, neck, or arms. To find out what's ailing you, consider heading back to your digestion specialist or seeking out a second opinion from another health care provider.

Before your appointment, you may want to jot down some notes or questions to you'd like to discuss with the provider. During your visit, let her/him know that the heartburn medication isn't working. Describe your symptoms in detail, and let the provider know exactly when and how much pain you've been experiencing. Ask the provider to explain your diagnosis so you can take part in choosing an appropriate treatment. When it comes to your health, you are your best advocate. Speaking up will give your health care provider the information s/he needs to take good care of you. The sooner you get back to her/him, the sooner you will have an explanation and the correct treatment for your discomfort!

Last updated Jun 02, 2015
Originally published Mar 31, 1994

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