That 'acidity' could be a heart attack: Medanta cardiologist Dr Nishant Tyagi shares warning signs you shouldn't miss

Heart attacks can manifest subtly with symptoms like nausea. It's vital to recognise these warning signs and seek medical help as acting quickly can save lives.

You know the movie scene — chest grab, gasp, collapse. In the real world, a heart attack is rarely that cinematic. Sometimes it just feels like acidity, getting tired too quickly at the gym, or exhaustion that you try to sleep off.

That gap between what we see on screen and what actually happens is what worries heart doctors the most. According to Dr Nishant Tyagi, director of interventional cardiology at Medanta Noida, the human body usually gives off warning signals long before a cardiac event turns critical.

The problem isn’t that the body stays silent; it’s that we are expert excuse-makers. We blame the spicy sabzi from lunch, a stiff neck from a bad pillow, or the stress of a long workweek. But misinterpreting those signals can cost you the most critical resource in emergency medicine: time.

The anatomy of misdirection

During an acute cardiac event, blood supply to a portion of the heart muscle is severely restricted or entirely cut off, explained Dr Tyagi, who has more than 22 years of clinical experience in invasive and non-invasive cardiology. The longer that blockage persists, the more heart tissue suffers irreversible damage.

Instead of an excruciating knife-like sensation, Dr Tyagi pointed out that patients frequently report 'pressure, tightness, squeezing, heaviness, fullness or discomfort in the centre or across the chest'. This sensation might persist for several minutes, ease up briefly, and then return with greater intensity.

The biggest pitfall is sitting on the sidelines, waiting to see if the discomfort escalates. "A common mistake is to wait until the pain becomes unbearable before seeking help. That is not advisable," Dr Tyagi warned, adding, “Even mild or unusual chest discomfort should be taken seriously, particularly if it occurs with other warning signs.”

During an acute cardiac event, blood supply to a portion of the heart muscle is severely restricted or entirely cut off, shared Dr Tyagi,

Beyond the chest: when symptoms travel

Part of what makes a heart attack so tricky to identify is the complex way the nervous system processes visceral pain. Discomfort originating in the heart frequently radiates along shared nerve pathways, manifesting in parts of the body that seem entirely unrelated. According to Dr Tyagi, "Heart attack symptoms are not necessarily limited to the chest. Discomfort can spread to one or both arms, the shoulders, back, neck, jaw or upper abdomen."

An unexplained ache in the jaw or a dull throbbing between the shoulder blades rarely brings the heart to mind. Most people dismiss it as a muscle strain. However, Dr Tyagi stressed that context is everything: "If it occurs together with breathlessness, sweating, nausea or chest discomfort, it should not be dismissed as a muscular problem or indigestion."

Shortness of breath, in particular, is a major red flag that often flies solo. "Sudden or unusual shortness of breath is another important warning sign," Dr Tyagi noted. "A person may feel unable to take a full breath, become unusually breathless after minimal activity, or develop breathlessness even while resting. Importantly, breathlessness can occur with or without chest discomfort," he added.

The 'acidity' trap

In many cultures — and particularly in Indian households where heavy spices and late dinners are common — the immediate instinct when feeling upper abdominal tightness is to reach for an antacid. Dr Tyagi cautioned against this automatic response: "Indigestion, acidity and heartburn are common, and most episodes are not related to the heart. However, heart attack symptoms can sometimes feel similar to indigestion."

He added, "A new or unexplained burning, heaviness or discomfort in the chest should therefore not simply be assumed to be acidity — especially if it is accompanied by sweating, breathlessness, nausea, dizziness or discomfort spreading."

This warning is doubly important for specific patient groups. Women, older adults, and individuals living with diabetes are far more likely to present with atypical symptoms. While chest discomfort remains common across all demographics, women frequently experience marked nausea, vomiting, acute fatigue, or lower back pressure rather than central chest pain, Dr Tyagi highlighted.

Heart attack symptoms can sometimes feel similar to indigestion.

Protocol for an emergency: what to do

If you or someone near you exhibits these overlapping warning signs, the immediate directive is simple: stop diagnosing and start acting. "Do not wait for the symptoms to disappear. Treat a suspected heart attack as an emergency," Dr Tyagi said, adding, "Call 112 [or your local emergency assistance number] immediately. Do not drive yourself to the hospital if emergency medical transport is available."

Taking an ambulance isn't just about avoiding traffic; emergency medical transport teams can perform preliminary diagnostic workups, administer initial stabilisation protocols, and notify the hospital’s cardiac catheterisation lab before you even clear the admissions doors.

While waiting for help, rest immediately. Stop all physical exertion and sit in a comfortable, supported position to reduce the strain on your heart, Dr Tyagi said. He added: consider aspirin (with caveats). "Aspirin can be useful during a suspected heart attack because it can reduce the formation of blood clots," Dr Tyagi said. However, he noted it isn't universal: "People with an aspirin allergy or certain bleeding risks should not take it."

Current guidance allows an alert adult with non-traumatic chest pain to chew and swallow a standard aspirin once emergency services are dispatched — provided there are no known allergies or contraindications. "If there is any uncertainty, it is reasonable to wait for medical professionals."

Dr Tyagi added that if the person becomes unresponsive and stops breathing normally, bystanders should initiate CPR and deploy an Automated External Defibrillator (AED) if available. "Perhaps the most important message is that a heart attack does not always look like the dramatic scene people see in films," Dr Tyagi reiterated. "When it comes to a possible heart attack, acting early is far safer than waiting to see whether the symptoms get worse," he concluded.

Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.