Angina and Acid Reflux Part 2: When Chest Pain Is an Emergency and How It’s Diagnosed
When you’re in the throes of chest pain, you want to know what is going on—and you want relief—as soon as possible. In Part 2 of this series, you’ll learn when your chest pain warrants immediate medical attention and what the diagnosis process is like. If you missed Part 1 of this guide, which covered distinguishing between angina and reflux, see it here.
When to Seek Medical Attention for Chest Pain
Not every type of chest pain signals a serious heart problem, but it should always be taken seriously.
Recognizing Emergency Symptoms
It can be stressful when you aren't sure what's causing your chest pain. Your mind might run through the possible causes...That big bowl of chili you ate? Maybe too much strenuous work today? A heart attack? Should you get help or ride it out?
If you’re already familiar with what acid reflux or angina feels like for you, then you probably also know how to handle it. Maybe you pop an antacid for reflux, or sit down to rest if you’re feeling angina pain. And if your typical symptoms escalate over time or suddenly feel more severe, it's time for an appointment with your doctor—not necessarily a trip to the ER.
If you’re already familiar with what acid reflux or angina feels like for you, then you probably also know how to handle it. Maybe you pop an antacid for reflux, or sit down to rest if you’re feeling angina pain. And if your typical symptoms escalate over time or suddenly feel more severe, it's time for an appointment with your doctor—not necessarily a trip to the ER.
The Importance of Prompt Medical Evaluation for Unexplained Chest Pain
Even though you may not relish the idea of heading to the emergency room or taking an ambulance ride, getting chest pain checked out is always the best plan. Getting a medical opinion may save your life, especially since heart problems don't always feel the way you expect or have heard.
Call 911 or your local emergency medical service right away if your chest pain is unfamiliar or comes on suddenly—especially if you’re experiencing any of the following heart attack symptoms:
Call 911 or your local emergency medical service right away if your chest pain is unfamiliar or comes on suddenly—especially if you’re experiencing any of the following heart attack symptoms:
- Severe pain in the center of the chest, such as pressure, squeezing, fullness, or pain
- Pain that radiates to other areas of the upper body, such as the arm, back, jaw, abdomen, or neck
- Shortness of breath, with or without chest pain
- Extreme fatigue with chest discomfort
How is Angina Diagnosed?
Once immediate, life-threatening problems have been eliminated as the cause of your chest pain, your medical team will investigate other possible causes of the pain using a variety of tests. Cardiac causes are always ruled out first.
Heart conditions are diagnosed through symptoms, medical tests, and imaging. For angina, which occurs when there's not enough oxygen reaching the heart through the coronary arteries, symptoms can vary. However, angina is suspected if chest discomfort is brought on by physical activity and goes away with rest.
Heart conditions are diagnosed through symptoms, medical tests, and imaging. For angina, which occurs when there's not enough oxygen reaching the heart through the coronary arteries, symptoms can vary. However, angina is suspected if chest discomfort is brought on by physical activity and goes away with rest.
Diagnostic Tools For Angina
Getting to a diagnosis of angina usually includes at least a couple of the following diagnostic tests:
- Stress Test - measuring how your heart works during a physical activity like walking or riding a stationary bike in the doctor's office. Imaging may also be used during the stress test to show how blood flows through the heart during exercise.
- ECG or EKG (electrocardiogram) - this is a painless, standard test that records the pattern of your heart's activity. It's typical to have an ECG performed as part of heart disease screening, and it's sometimes given in conjunction with a stress test.
- Angiogram - is an imaging procedure that uses X-rays, an injection of dye, and a thin tube called a catheter that is threaded into a blood vessel. The procedure is used to diagnose a variety of blood vessel-related issues, including arterial disease (blockages and narrowing of the vessels), which is a common cause of angina.
How is Reflux-Related Chest Pain Diagnosed?
When heart problems have been eliminated as a cause of your chest pain, the investigation into why you have this pain will continue. It is common for people to confuse acid reflux for heart pain, so it's logical that your medical team will look into the possibility that you have reflux or gastroesophageal reflux disease (GERD). The diagnosis of GERD is multifaceted and relies on a combination of techniques. A clinical exam and discussion of your symptoms might be the first step. It's helpful if you can accurately relay your symptoms to your doctor (check this resource to help you describe yours).
If it's believed that reflux is the culprit, and if you have no other alarming symptoms that warrant immediate medical treatment, it's likely you'll be put on a multi-week trial of medication to see if it alleviates the pain. It's common to be prescribed a Proton Pump Inhibitor (PPI) medication to be taken daily for 8 weeks, after which you'll again see your doctor for follow-up. If the PPI trial is not effective, there are several potential next steps.
If it's believed that reflux is the culprit, and if you have no other alarming symptoms that warrant immediate medical treatment, it's likely you'll be put on a multi-week trial of medication to see if it alleviates the pain. It's common to be prescribed a Proton Pump Inhibitor (PPI) medication to be taken daily for 8 weeks, after which you'll again see your doctor for follow-up. If the PPI trial is not effective, there are several potential next steps.
Diagnostic Approaches for Reflux
If other issues are present alongside suspected reflux or GERD, two additional diagnostic methods may be used—not only to confirm or exclude reflux, but also to evaluate the associated conditions. These might include:
pH Monitoring
There are two types of pH monitoring tests that may be employed if a PPI trial doesn't help, or if an endoscopy doesn't reveal evidence of GERD. Both measure the acid that reaches your esophagus, which might be causing your chest pain.
- Wireless esophageal pH testing, or a Bravo pH test, is a way to measure the amount of acid you produce, how often it comes back up into the esophagus, and how long it remains there. A procedure to place a sensor in your GI tract is required. Either a tube will be inserted through your mouth or nose and down into your esophagus, where the sensor will be deposited (and the tube removed), or you'll swallow the sensor in a capsule. While you go about your daily life for a few days, the sensor will transmit data to a receiver worn around your waist or attached to your belt. Then the sensor will pass through your system and be eliminated in a bowel movement. After you return the receiver to your physician, the data will be evaluated to confirm or rule out GERD and to help determine next steps.
- 24-hour pH impedance testing is a way to monitor acid in a shorter amount of time, but it's perceived as less comfortable since the tube that holds the sensor remains in place, and the other end of it is looped over your ear and connected to the receiver that you wear at your waist. You may eat and drink as usual, and return to the physician's office the next day to have the tube removed and the receiver returned for evaluation.
Endoscopy
Endoscopy is a method of examining the gastrointestinal (GI) tract using a tube with a light and a camera at its tip. Not everyone with suspected reflux will have an endoscopy, and it will be limited to the upper GI tract (an "upper endoscopy"). It's typically reserved for those with suspected GERD who have some additional issues, such as weight loss, vomiting, GI bleeding, dysphagia, or multiple risk factors for Barrett's Esophagus. If other tests (e.g., pH monitoring) are inconclusive, endoscopy may be the next step.
Don't forget to check out Part 3 of the Angina and Reflux series, where we'll cover new research on the links between heart disease and reflux, and how to manage living with both conditions.
FAQs
When should chest pain be treated as a medical emergency?
Chest pain should be treated as an emergency if it is sudden, severe, unfamiliar, or accompanied by symptoms such as shortness of breath, pain radiating to the arm, jaw, neck, back, or abdomen, extreme fatigue, dizziness, or a feeling of pressure or squeezing in the chest. If you suspect a heart attack, call 911 or your local emergency services immediately.
How do doctors determine whether chest pain is caused by angina or acid reflux?
Healthcare providers typically rule out heart-related causes first because they can be life-threatening. Diagnosis may involve a medical history, physical examination, electrocardiogram (ECG/EKG), stress testing, imaging studies, or other cardiac evaluations. If heart disease is excluded, testing may then focus on conditions such as acid reflux or GERD.
What tests are commonly used to diagnose angina?
Common diagnostic tests for angina include an electrocardiogram (ECG/EKG), stress testing, and imaging procedures such as an angiogram. These tests help evaluate heart function, blood flow, and the presence of narrowed or blocked coronary arteries that may be contributing to chest pain.
How is GERD diagnosed when reflux is suspected?
GERD is often diagnosed using a combination of symptom assessment, medical history, and response to treatment. In some cases, a healthcare provider may recommend a trial of proton pump inhibitor (PPI) medication. Additional testing, such as esophageal pH monitoring or upper endoscopy, may be used if symptoms persist, the diagnosis remains uncertain, or alarm symptoms are present.
What symptoms might require an endoscopy if GERD is suspected?
An upper endoscopy may be recommended if reflux symptoms occur alongside concerning signs such as difficulty swallowing, unexplained weight loss, persistent vomiting, gastrointestinal bleeding, or risk factors for Barrett's esophagus. Endoscopy allows healthcare providers to directly examine the upper digestive tract and identify potential complications or alternative causes of symptoms.
References
1U.S. Department of Health and Human Services. (n.d.). What is angina?. National Heart Lung and Blood Institute. https://www.nhlbi.nih.gov/health/angina
2Warning signs of a heart attack. www.heart.org. (2024, December 12). https://www.heart.org/en/health-topics/heart-attack/warning-signs-of-a-heart-attack
3Manolis, A. J., Collins, P., & López-Sendón, J. (2025). Diagnosing and treating stable angina: a contemporary approach for practicing physicians. Future cardiology, 21(5), 291–303. https://doi.org/10.1080/14796678.2025.2479970
4Exercise stress test. www.heart.org. (2025, February 24). https://www.heart.org/en/health-topics/heart-attack/diagnosing-a-heart-attack/exercise-stress-test
5U.S. Department of Health and Human Services. (2022, March 24). Heart tests. National Heart Lung and Blood Institute. https://www.nhlbi.nih.gov/health/heart-tests
6Katz, P. O., Dunbar, K. B., Schnoll-Sussman, F. H., Greer, K. B., Yadlapati, R., & Spechler, S. J. (2022). ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease. The American journal of gastroenterology, 117(1), 27–56. https://doi.org/10.14309/ajg.0000000000001538
7Wireless esophageal ph test (bravo test) . Johns Hopkins Medicine. (n.d.). https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/wireless-esophageal-ph-test
824-hour PH-impedance testing . Johns Hopkins Medicine. (n.d.-a). https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/24-hour-ph-impedance-testing
9Simadibrata, D. M., Lesmana, E., & Fass, R. (2023). Role of endoscopy in gastroesophageal reflux disease. Clinical endoscopy, 56(6), 681–692. https://doi.org/10.5946/ce.2023.182
10Upper Gi Endoscopy . Johns Hopkins Medicine. (n.d.-b). https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/upper-gi-endoscopy
11U.S. Department of Health and Human Services. (2024, August). Definition & facts for Barrett’s esophagus . National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/barretts-esophagus/definition-facts
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