DEFINITION
Heartburn is a burning sensation felt in your chest, usually localized in the area behind the breastbone. It is a symptom, not a disease itself, of acid reflux, and despite its name, it has nothing to do with the heart.

CAUSES, TRIGGERS AND PREVALENCE
Heartburn, the feeling that your stomach or, more frequently, your chest at the level of the breastbone is burning, is the result of acid reflux. In order to comprehend this, you first need to grasp the basics of how you eat and digest. When food is chewed, it is broken down by saliva and the enzymes (protein substances) contained in it to simpler elements. It is then forwarded through a long pipe, called the esophagus or food pipe, to the stomach, where acid helps to further break it down to a simpler form, so that it can be digested and passed through the small bowel.

At the bottom part of your esophagus lies the lower esophageal sphincter (LES). This circular band’s function is to ensure that, once food reaches the stomach, it will stay there and not travel back to the esophagus. If the sphincter fails to execute this function, partly digested or undigested food and gastric acid travel all the way up the esophagus, sometimes even reaching the mouth. If this happens more than 2 times per week, you may be affected by the disease known as GERD- gastroesophageal reflux disease.

The American College of Gastroenterology reports that approximately 60.000.000 individuals have an incident of heartburn once a month. Both isolated acid reflux and GERD are extremely common in the industrialized world. Causes vary; sometimes the phenomenon of heartburn and LES failure is idiopathic, namely, no cause can be identified, sometimes it fails because of the presence of a hiatal hernia. This is a hernia that results in the stomach being moved up in the chest, leading to acid reflux.

The symptom of heartburn is usually triggered when you eat too much or eat too greasy food, that the stomach cannot easily digest. Pregnancy and obesity are also risk factors for acid traveling back up to the esophagus. Alcohol, smoking, lack of exercise and caffeine are possible culprits that can trigger an episode of heartburn; they should, however, be viewed as triggers and not causes. Not every person who smokes and does not engage in physical activity is expected to develop heartburn or GERD.

PRESENTATION
Heartburn is described as a burning sensation felt in one’s stomach or, most frequently, in the chest behind the breastbone. It is experienced after consuming food or drinks, not when the stomach is empty. Sometimes, undigested food or acid can reach the mouth, leaving a bitter taste. If the symptom of heartburn is experienced twice in a week or more often, you may have GERD. GERD is associated with other symptoms as well, such as bloating, a dry cough, bad breath, a sore throat or recurring episodes of laryngitis and the feeling of nausea. Vomiting can also occur.

HEARTBURN VS HEART ATTACK- WHEN TO SEEK TREATMENT
Heartburn or even GERD symptoms do not constitute a medical emergency. If you feel either heartburn or any of the aforementioned accompanying symptoms you should definitely call your doctor to schedule an appointment but no immediate action is required. However, severe manifestations of heartburn can be mistaken for a heart attack and vice versa; the vice versa is the part we should be cautious of.

If the burning sensation is also painful if the pain radiates to the arm/arms, throat, or back, if you need to sit still for the symptoms to alleviate but then they return, you may be having a heart attack. You need to go to a healthcare facility right away. Many times it is difficult to know whether you are having a heart attack or the heartburn has got worse; in these cases, it is best to assume that the worse scenario, that of the heart attack, is taking place.

Symptoms and signs of a heart attack:
• Pain in the center of the chest
• Pain that radiates to the throat, back, shoulder, jaw, right arm, left arm or both arms
• Pain that is better when you lie or sit still and perform no movement
• Pain that has the characteristics mentioned above and lasts for at least 20 minutes
• Syncope (fainting)
• Sweating
• Nausea or vomiting

Even if you already know you have GERD, do not attribute the symptoms mentioned in the bullets to your gastroesophageal condition. Call 911 immediately.

WORKUP
Your doctor will take a detailed medical history, including frequency of symptoms, which foods cause them and a family history. They will also take your vitals (blood pressure, oxygen, pulse rate) and perform an electrocardiogram. Depending on the precise symptomatology, they may suggest endoscopy or blood tests. Further testing may be necessary to diagnose GERD accurately.

TREATMENT
If you have a diagnosed GERD or heartburn less than 2 times each week, it would be best for you to avoid certain foods, such as:
• Chocolate
• Greasy, fatty food
• Fried food
• Alcohol
• Caffeine
• Any type of food which causes you indigestion

You can also try to eat smaller meals, so as not to overstrain your stomach, and avoid lying down for at least 2 hours after you consume food. Try to keep a better, upright posture when sitting or standing and, if you have a smoking habit, try to quit. Sometimes, wearing clothes that are not too tight on your stomach also helps. If these simple tips do not provide enough relief, you can also take an antacid pill, such as Gaviscon.

Before taking the pill. Make sure you are not experiencing any heart-attack-related symptoms; if you have any doubts as to the origin or characteristics of your pain, it is better to call 911 even if you are not diagnosed with a heart attack in the hospital. If, after taking the antacid pill, you develop a rash, experience dyspnea, shortness of breath, or gastrointestinal symptoms such as diarrhea, immediately call 911 and do not take another drug because you are probably having an allergic reaction.

POPULAR MISCONCEPTIONS
• I have had episodes of heartburn for some time and right now I am feeling a tingling sensation in my chest, tingling in my arm and jaw. I will take an antacid to relieve the symptoms.

Call 911 instead. If your heartburn changes in terms of characteristics, and if the feeling radiates to your arm, jaw, back or both arms, you may be having a heart attack. Given that approximately 1/3 of people succumb to heart attacks before they reach the hospital, it is in your best interests to call the emergency services and not wait it out.