How can symptoms of cardiac causes of chest pain be distinguished from other such as gastrointestinal causes or panic attacks?

Hi I'm Sukh Nidja and I'm an interventional cardiologist working in central London. One of the most challenging things that we have to do is to identify whether a patient is having a heart related symptom or something that could be innocuous as trapped wind or perhaps anxiety or panic. It's really hard to tell the difference between these symptoms and it means that we have to listen very hard to what the patient is telling us, perform some examinations and also perform some investigations. Let's think about the different symptoms that an individual may have. A lot of these symptoms overlap quite dramatically and that's because there's not a lot of space inside our body and the heart sits right on top of the stomach and the oesophagus, the food pipe, and that's why it can be very confusing to tell the difference between these different conditions. Also the nerves that supply both the stomach and the heart are all coming from the same place, they're all coming from the vagal nerve and that's why the signals can be a little bit mixed up inside our body and can be really difficult to tell the difference. Something that tells us it's more likely to be the heart is if a patient's symptoms of chest discomfort are occurring whenever they're doing some activity, whenever they're exerting themselves and perhaps radiating up into their neck or into their arm. Things that are more likely to be gastric and to do with trapped wind or reflux are more likely to be in the upper part of the belly. They're more likely to occur after food and it's more likely to be a burning sensation. Some people may feel better if they've had some milk or some cold water or if they avoid certain foods. They may also feel better if they belch or pass wind. Those things all imply a gastric cause. Gastric issues are more likely also if the patient is noticing the symptoms when they're lying down or when they recline and they might even notice some acid coming up into their throat. If we think you've got gastric related issues it's often that we're asked to exclude the heart as a driver first and so most cardiologists will perform some investigations to check the heart either through ECG testing and echocardiography and then some other tests in order to determine whether the heart really is causing your symptoms. If it turns out that it's related to your stomach we may ask you to see a gastroenterologist and they may well consider some further investigations including endoscopy which is a passing of a tube into the stomach to have a look inside. Trying to distinguish some of these symptoms from panic is actually very difficult as well. Sometimes people with genuine heart related problems get labeled as having panic attacks and so it's really important that we spend some time listening to the symptoms and identifying what happens when and just really tease out the symptom profile to try and understand whether this was a panic attack, whether this was genuinely a heart related issue. Sometimes when we don't know we may do some heart testing to be certain. It can be very difficult and that's why we often rely on a number of different factors including how you felt, your risk factor profile, our examination findings and some test findings to put everything together.