Indigestion is common. Heart attacks are common, too. Unfortunately, the sensations can sometimes be similar, particularly for older adults.
That makes one distinction especially important: when new or unexplained symptoms could be coming from the heart, time matters. Waiting to see whether the discomfort goes away can delay treatment during a heart attack.
The American Heart Association specifically warns that heartburn and heart-related chest pain are easy to confuse. Its advice is straightforward. If you are unsure whether your symptoms are heartburn or your heart, seek medical attention right away.[1]
Heart Attacks Do Not Always Feel Like Crushing Chest Pain
Many people picture a heart attack as sudden, severe pain in the middle of the chest. That certainly can happen. Other heart attacks produce symptoms that are easier to dismiss.
The 2021 American Heart Association and American College of Cardiology guideline on chest pain notes that symptoms related to inadequate blood flow to the heart can include shortness of breath, sweating, lightheadedness, nausea, vomiting, upper abdominal pain and even heartburn that is unrelated to meals.[2]
Older adults deserve particular attention. MedlinePlus notes that some older people who are having a heart attack may experience little or no chest pain. Shortness of breath, fatigue and weakness may be among the symptoms instead.[3]
The National Institute on Aging similarly includes nausea, vomiting and stomach upset among possible heart attack warning signs. The agency cautions people against assuming sudden chest discomfort is something minor.[4]
What Researchers Found in Older Heart Attack Patients
Researchers in the SILVER-AMI study looked specifically at 2,500 people age 75 and older who had been hospitalized with a heart attack at 94 hospitals across the United States.[5]
About 21% arrived without chest pain. Among these patients, common symptoms included shortness of breath, weakness or fatigue, arm or shoulder pain, indigestion and nausea. Indigestion was reported by about one in five of the patients who did not have chest pain.[5]
Recognition was also a problem. Among heart attack patients who experienced chest pain, 56.4% correctly believed that their symptoms were related to their heart. Among those who had symptoms without chest pain, only 26.6% recognized a possible cardiac cause.[5]
Those less-recognized symptoms mattered because they were associated with delays in reaching the hospital. The researchers defined a significant pre-hospital delay as waiting six hours or longer after symptoms began. Patients without chest pain were more likely to experience such a delay.[5]
For an older adult thinking, “Maybe I just ate something that disagreed with me,” those hours can be important.
Symptoms Worth Taking Seriously
Heartburn commonly causes a burning discomfort behind the breastbone as stomach acid moves into the esophagus. The discomfort can sometimes extend toward the neck, throat or jaw.[1] Because the heart and esophagus sit close together, symptoms originating from either area can feel surprisingly similar.
Possible heart attack symptoms can include:
Pressure, squeezing, fullness, burning or pain in the chest
Pain or discomfort in the arms, shoulders, back, neck, jaw or upper abdomen
Shortness of breath
Cold sweats
Nausea, vomiting or stomach upset
Lightheadedness or fainting
Unusual fatigue or weakness[1-4]
A person does not need to experience every symptom on that list. Older adults may have a less obvious combination of symptoms.[2,3]
When You Are Not Sure, Do Not Spend Time Trying to Diagnose Yourself
Recurring heartburn that has already been evaluated by a healthcare professional is familiar territory for many people. New, unusual, severe or unexplained symptoms deserve more caution.
The American Heart Association’s consumer guidance puts the issue simply: when you cannot tell whether the problem is heartburn or your heart, get medical help.[1]
For symptoms that may indicate a heart attack, call 911. The National Institute on Aging recommends emergency medical services rather than driving yourself to the hospital, because treatment can begin on the way and emergency personnel can respond if the patient’s condition suddenly worsens.[4]
Family members and caregivers can help, too. A senior who suddenly complains of indigestion along with weakness, unusual fatigue, shortness of breath, sweating or other unexplained symptoms may need more than an antacid and some time to rest.
Knowing that heart attacks can sometimes masquerade as stomach trouble gives older adults and the people around them one more opportunity to recognize an emergency quickly. When the symptoms are uncertain, timing matters.
SOURCES
American Heart Association. Heartburn or Heart Attack? American Heart Association. Last reviewed January 28, 2025.
Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2021.
MedlinePlus. Heart attack. U.S. National Library of Medicine, National Institutes of Health.
National Institute on Aging. Heart Health and Aging. National Institutes of Health.
Ouellet GM, Geda M, Murphy TE, Tsang S, Tinetti ME, Chaudhry SI. Pre-hospital delay in older adults with acute myocardial infarction: the SILVER-AMI study. J Am Geriatr Soc. 2017;65(11):2391-2396. doi:10.1111/jgs.15102.
