Can a Hiatal Hernia Feel Like a Heart Attack?

Heart Attack vs. Hiatal Hernia: Differences, Similarities, and Pictures

Picture of a Heart Attack.
Heart attacks and hiatal hernias both may initially cause no symptoms.
Picture of Hiatal Hernia.
Coughing is a symptom of hiatal hernia.
  • Heart attack occurs when a blood clot partially or completely blocks a blood vessel in the heart. The clot stops oxygen delivery to the muscle beyond the clot, which causes that portion of the heart muscle to die.
  • A hiatal hernia is a digestive (gastroesophageal, GI) tract condition in which part of the stomach pushes up through the diaphragm into the chest cavity.
  • Many people having a heart attack or those who have a hiatal hernia have no symptoms. However, when symptoms do occur, they both cause chest pain that may radiate to the arm, back, and neck.
  • Heart attack symptoms and signs that are different hiatal hernias include shortness of breath and chest pain (which may feel like a tightness, fullness, pressure, or ache), profuse sweating, and nausea.
  • Other signs and symptoms of a heart attack may include:
    • Heart palpitations
    • Jaw ache
    • The pain only in the shoulders or arms
  • A woman having a heart attack also may also have symptoms and signs like extreme weakness and fatigue.
  • Hiatal hernia symptoms and signs that are different from a heart attack include:
  • A hiatal hernia can mimic heart attack symptoms, but they are not related.
  • Heart attacks are caused by a buildup of plaque in the arteries, which results in a coronary artery becoming blocked, while heartburn is a symptom of another digestive problem that causes stomach acid to back up or reflux into the esophagus.
  • Usually, a hiatal hernia and its symptoms are not life-threatening.

Heart attacks are a life-threatening emergency. If you think you or someone you are with is having a heart attack call 911 immediately.

What Is a Heart Attack? What Is a Hiatal Hernia?

A heart attack is due to a blood clot or a partially or completely blocked blood vessel in the heart from a blood clot or narrowed or completely occluded blood vessel. This causes slow or lack of blood flow to areas of the heart where the vessel is blocked. Lack of oxygen to the portion of the heart affected causes heart muscle in that area to die.

Hiatal hernia is a common gastrointestinal (GI or digestive) tract condition in which the upper portion of the stomach protrudes into the chest cavity through an opening of the diaphragm called the esophageal hiatus. This opening usually is only large enough to accommodate the esophagus. With weakening and enlargement, however, the opening (or herniation) can allow upward passage (herniation) or even entrapment of the upper stomach above the diaphragm. Some people have a hiatal hernia to some degree by age 60; moreover, up to 60% of people have it to some degree. There are two types of hiatal hernia.

  • Sliding hiatal occurs when the junction between the stomach and esophagus slides up through the esophageal hiatus during moments of increased pressure in the abdominal cavity. When the pressure is relieved, the stomach falls back down with gravity to its normal position.
  • A fixed hiatal hernia (paraesophageal) does not slide up and down because a portion of the stomach remains stuck in the chest cavity.

Which Symptoms and Signs of Heart Attack and Hiatal Hernia Are Different? Which Are the Same?

Heart Attack Warning Symptoms and Signs

Classic symptoms of a heart attack may include

  • chest pain associated with shortness of breath,
  • profuse sweating, and
  • nausea.

The chest pain feels like a tightness, fullness, pressure, or ache, which may radiate from the chest to the neck, jaw, shoulder, or back, associated with shortness of breath, nausea, and sweating.

Unfortunately, many people do not have these classic signs. Other signs and symptoms of heart attack may include

  • indigestion,
  • jaw ache,
  • the pain only in the shoulders or arms,
  • shortness of breath, or
  • nausea and vomiting.

This is NOT a complete list of heart attack symptoms and signs since many people can experience a heart attack with minimal symptoms. In women and the elderly, heart attack symptoms can be atypical and sometimes so vague they are easily missed. The only symptom may be extreme weakness or fatigue. The chest pain may also radiate from the chest to the neck, jaw, shoulder, or back and be associated with shortness of breath, nausea, and sweating.

Hiatal Hernia Symptoms and Signs

For most people, a hiatal hernia by itself causes no symptoms. When symptoms do occur, they include:

  • Chest pain or pressure
  • Heartburn
  • Difficulty swallowing
  • Coughing
  • Belching
  • Hiccups

Pain: At times, a hiatal hernia causes chest pain or upper abdominal pain when the stomach becomes trapped above the diaphragm through the narrow esophageal hiatus. Rarely, in a fixed hiatal hernia the blood supply is cut off to the trapped portion of the stomach, which causes extreme pain and serious illness. This is called a strangulated hiatal hernia, and it is a medical emergency.

Hiatal hernia also causes symptoms of discomfort when it is associated with a condition called gastroesophageal reflux disease (GERD). GERD is characterized by regurgitation of stomach acids and digestive enzymes into the esophagus through a weakened sphincter that is supposed to act as a one-way valve between the esophagus and stomach. Hiatal hernia is thought to contribute to the weakening of this sphincter muscle.

Although it is true that a hiatal hernia or GERD can cause chest pain like angina (or heart pain) including chest pressure that can radiate to the arm or neck, do not assume that such pain is caused by the less serious condition of the two. When in doubt, it is safer to be seen by a doctor immediately in order to rule out more serious problems first.

What Causes a Heart Attack and Hiatal Hernia?

Heart Attack Causes

Over time, plaque can build up along the course of an artery and narrow the channel through which blood flows. Plaque is made up of cholesterol buildup and eventually may calcify or harden, with calcium deposits. If the artery becomes too narrow, it cannot supply enough blood to the heart muscle when it becomes stressed. Just like arm muscles that begin to ache or hurt when heavy things are lifted, or legs that ache when you run too fast; the heart muscle will ache if it doesn't get adequate blood supply. This ache or pain is called angina. It is important to know that angina can manifest in many ways and does not always need to be experienced as chest pain.

If the plaque ruptures, a small blood clot can form within the blood vessel, acting like a dam and acutely blocking the blood flow beyond the clot. When that part of the heart loses its blood supply completely, the muscle dies. This is called a heart attack, or an MI - a myocardial infarction (myo=muscle +cardial=heart; infarction=death due to lack of oxygen).

Hiatal Hernia Causes

Suspected causes or contributing factors

When to Call a Doctor for Heart Attack Symptoms or Hiatal Hernia

When to call the doctor heart attack warning signs or symptoms

Chest pain is almost always considered an emergency. Aside from heart attacks, pulmonary embolus (blood clot in the lung) and aortic dissection or tear can be fatal causes of chest pain. Classic pain from a heart attack is described as chest pressure or tightness with radiation of the pain to the jaw and down the arm, accompanied by shortness of breath or sweating. But it is important to remember that heart problems may not always present as pain or with the classic symptoms. Indigestion, nausea, profound weakness, profuse sweating, or shortness of breath may be the main symptom of a heart attack.

If you have any symptoms that you believe are related to your heart, call 911. First responders, emergency medical technicians, and paramedics can begin testing and treatment even before you arrive at the hospital. Remember to take an aspirin immediately if you are concerned that you are having a heart attack.

Many people die before they seek medical care because they ignore their symptoms out of fear that something bad is happening, or by diagnosing themselves in error with indigestion, fatigue, or other illnesses. It is much better to seek medical care if you are unsure whether your symptoms are related to heart disease and find that all is well than to die at home.

When to Call the Doctor for Hiatal Hernia Symptoms

When to call the doctor

  • When the symptoms of a hiatal hernia are new, persistent (won't go away), or severe
  • When it is not clear what is causing your symptoms

When to go to the hospital

  • When you have chest pressure or pain, especially if you have known heart disease or these coronary risk factors: diabetes, smoking, high cholesterol, high blood pressure, older than 55 years, male gender, or family history of early heart attacks or angina (before age 55 years)
  • Vomiting blood
  • Dark, tarry stools
  • Palpitations (feel heart beating in your chest) or feeling faint
  • A cough and fever
  • Shortness of breath
  • Inability to swallow solid food or liquids easily

Acid Reflux Symptoms

Acid reflux is a digestive (GI, gastrointestinal) tract problem in which acid backs up from the stomach into the esophagus, and even up into the throat. The acid refluxing irritates the tissues lining the throat. Symptoms of acid reflux include heartburn, regurgitating bitter acid into the throat, bitter taste in mouth, chest pain, dry cough, hoarseness, feeling of tightness in the throat, and wheezing.

Qureshi, WA, MD. Hiatal Hernia. Medscape. Updated: Jan 03, 2016.

Zafari, MA, MD. Myocardial Infarction. Medscape. Updated: Feb 12, 2018.