A reader of our Picture of Health blog asked recently how to distinguish the symptoms of heartburn from the symptoms of a heart attack.

It turns out to be harder than you might think. Dr. Richard A. Desi, a gastroenterologist at the Institute for Digestive Health and Liver Disease at Baltimore's Mercy Medical Center, discussed how to tell the difference.

"That's actually not a very easy question," Desi said. "It's a difficult question for patients and for doctors."

One key, he said, is to look for what are considered the classic symptoms of each. With heartburn, burning sensations are likely to radiate from the center of the stomach and into the chest. Typically those symptoms will improve when you take an antacid and worsen when you lie down. It can be set off by a meal.

With a heart attack, the common sensation is left-sided chest pain, radiating down the left arm with numbness or tingling. It can be accompanied by shortness of breath and can be set off by physical exertion.

But sometimes, Desi says, the typical symptoms don't appear and sometimes they will overlap, making it hard to know the difference. His advice: If you've never had the pain before, have it checked out by a doctor. "It's probably something that you shouldn't be gambling with," he says, considering that heart disease is the No. 1 killer in the United States.

Desi says some people are sent to his office from the emergency room, where they raced after thinking they were having a heart attack only to be told it was acid reflux instead. "It's better to err on the side of being a little bit embarrassed," he says.

There are other digestive conditions besides heartburn that can cause discomfort in your chest, according to a primer on the Mayo Clinic's Web site. You might have a muscle spasm in your esophagus, or a gallbladder attack, the site says. A fatty meal could lead to nausea and "an intense, steady ache in the right abdomen. The pain may shift to your shoulders, neck or arms."

Desi says it can be even harder for women to distinguish the symptoms of heartburn from those of a heart attack than it is for men.

"Women may not necessarily exhibit the 'classic' heart attack symptoms such as left-sided chest pain extending to the left arm," the doctor said. "They may have nonspecific symptoms that can be interpreted as indigestion or heartburn. That is why it is important to seek medical attention, especially if you have risk factors for a heart attack (family history, diabetes, smoking, high blood pressure, and high cholesterol).

"Remember, this can be challenging for physicians as well, so certainly don't gamble with your health by assuming your symptoms are always heartburn."

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