Q: How is chest pain from heartburn different from that of a heart attack?

A: People do mistake these two pains for one another, especially because many of those in the high-risk group for heart attacks -- overweight middle-aged men, who may eat rich diets and not exercise much -- are also likely to develop heartburn.

Typically, heart pain feels like a pressure or squeezing, or weight or tightness in the middle of the chest, with pain possibly radiating into the neck, jaw or shoulders and possibly shortness of breath and sweating. Heart pain usually comes on with exertion and gets better with rest.

Intestinal disorders like heartburn more typically cause a burning feeling in the chest and esophagus. Heartburn usually occurs after eating, is worse when a patient lies down to rest, often goes away with an antacid and is not associated with exercise.

The problem is, there is so much variability in what heartburn and heart pain might feel like that it can be difficult to tell the difference without tests. Some patients do experience a burning sensation in the chest with heart pain, especially during a heart attack. Denial-- which convinces patients that severe heart pain is heartburn -- is also a problem. Generally, if the pain is so bad that you have to go home from work, you should probably go to the hospital emergency room.

The biggest opportunity to save heart muscle is in the first few hours of a heart attack. Six or eight hours into it, we can still do some good, but much less. Tests and technology make ruling out -- or ruling in -- a heart condition easier and much faster. If you suspect you are having a heart attack, call 911. In the emergency room, we can rule out heart problems in less than 24 hours or, if necessary, begin treatment. Clearly, your chances of surviving a heart attack are much greater the sooner you receive diagnosis and treatment.