Heartburn is a burning sensation in your chest, just behind your breastbone.  Occasional heartburn is common and no cause for alarm. Most people can manage the discomfort of heartburn on their own with lifestyle changes and over-the-counter medications.

Heartburn occurs when stomach acid backs up into your esophagus. Normally when you swallow, your lower esophageal sphincter — a circular band of muscle around the bottom part of your esophagus — relaxes to allow food and liquid to flow down into your stomach. Then it closes again.  However, if the lower esophageal sphincter relaxes abnormally or weakens, stomach acid can flow back up into your esophagus, causing heartburn. The acid backup may be worse when you're bent over or lying down.

Heartburn that occurs frequently and interferes with your routine is considered gastroesophageal reflux disease (GERD). GERD treatment may require prescription medications and, occasionally, surgery or other procedures. GERD can damage the esophagus and cause serious complications.

When to see a doctor

Seek immediate help if you experience severe chest pain, especially when combined with other signs and symptoms such as difficulty breathing or jaw or arm pain. Chest pain may be a symptom of a heart attack.

Most doctors recommend that you should make an appointment with your doctor if:

  • Heartburn occurs more than twice a week
  • Symptoms persist despite use of over-the-counter medications
  • You have difficulty swallowing

What can you do to reduce the symptoms of heartburn?

Certain foods and drinks can trigger heartburn in some people and should be avoided to reduce symptoms. These include:

  • Alcohol
  • Black pepper
  • Chocolate
  • Coffee
  • Fatty food
  • Fried food
  • Ketchup
  • Mustard
  • Onions
  • Orange juice
  • Peppermint
  • Soft drinks
  • Tomato sauce
  • Vinegar

Elevate the head of your bed. If you regularly experience heartburn at night or while trying to sleep, put gravity to work for you. Place wood or cement blocks under your bed so that the head of the bed is raised by ~ six inches. If it's not possible to elevate your bed, you can insert a wedge between your mattress and box spring to elevate your body from the waist up. Wedges are available at drugstores and medical supply stores. Raising your head with additional pillows is not effective.

Avoid tobacco. Smoking decreases the lower esophageal sphincter's ability to function properly.

Anxiety and stress can worsen heartburn symptoms. Some complementary and alternative treatments may help you cope with anxiety and stress. If your heartburn is worsened by anxiety and stress, consider trying:

  • Aromatherapy
  • Gentle exercise, such as walking or riding a bike, but avoid vigorous exercise, which can worsen
  • heartburn
  • Hypnosis
  • Listening to music
  • Massage
  • Relaxation techniques, such as guided imagery

Distinguishing between heartburn and a heart attack?

Chest pain is one of the most common reasons for trips to the emergency room. While many of these patients are suffering from a heart attack, a life-threatening situation, some actually may be experiencing severe heartburn.

Often, the pain caused by a heart attack and during a severe heartburn episode is so difficult to distinguish that sophisticated medical testing is needed to determine whether or not you are having a heart attack. To complicate matters even more, the two problems have many of the same symptoms and occur in similar groups of people (older age, overweight, etc.).

Here are some possible differences between the two conditions.

Note: If you have any chest pain that lasts for more than a few minutes—or any warning signs of a heart attack—do not try to decide for yourself. Seek immediate medical attention.

Possible signs of heartburn

  • A sharp, burning sensation just below the breastbone or ribs
  • Pain generally does not radiate to the shoulders, neck, or arms, but it can.
  • Pain usually comes after meals, when lying on the back, when exercising, or when experiencing anxiety.
  • Symptoms usually respond quickly to antacids.
  • Symptoms are rarely accompanied by a cold sweat.

Possible signs of angina or heart attack

  • A feeling of fullness, tightness, or dull pressure or pain generally in the center of the chest
  • The feeling of a belt being tightened around your chest
  • Sudden chest pain or pressure that worsens
  • Dizziness
  • Pain may spread to the shoulders, neck, jaw, or arms.
  • Often responds quickly to nitroglycerin
  • Shortness of breath
  • Usually accompanied by a cold sweat
  • Lightheadedness (sometimes)