What Does the Burning Sensation of Cardiac Ischemia Feel Like?
Burning is one of several recognized descriptors patients use for cardiac ischemia, though it carries a lower probability of ischemic origin compared to classic descriptors like pressure, squeezing, or heaviness. 1
Characteristics of the Burning Sensation
When patients describe a "burning" sensation with cardiac ischemia, they typically experience:
- A substernal or central chest discomfort that may feel like heat or burning rather than sharp pain
- Location: Usually retrosternal (behind the breastbone), but can radiate to the shoulders, arms, jaw, neck, back, or upper abdomen 1
- Quality: Patients may describe it as a "hot feeling," "burning," or sensation of heat in the chest 2
- Duration and triggers: The burning typically occurs with exertion or emotional stress and is relieved by rest or nitroglycerin when truly ischemic 1
Clinical Context and Probability
According to the 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guidelines, burning appears in the right-sided column of the Index of Suspicion figure, indicating it has a lower probability of representing ischemia compared to descriptors like pressure, squeezing, gripping, heaviness, or tightness, which appear in the central/left-sided columns 1.
The most classic ischemic descriptors are:
- Pressure
- Squeezing
- Gripping
- Heaviness
- Tightness
- Exertional/stress-related symptoms
- Retrosternal location
Critical Pitfall to Avoid
Do not dismiss burning chest discomfort as non-cardiac based on the descriptor alone. The guidelines explicitly state that patients often do not use the word "pain" and may report various sensations including burning 1. The term "chest discomfort" is more appropriate than "chest pain" because patients describe their symptoms variably.
Never use the term "atypical" to describe chest pain that doesn't fit classic patterns, as this can lead to misinterpretation as benign when it may still be cardiac in origin 1. Instead, classify symptoms as "cardiac," "possibly cardiac," or "noncardiac."
Additional Diagnostic Considerations
The burning quality alone does not determine cardiac origin. You must assess:
- Provoking factors: Does exertion or emotional stress trigger it?
- Relieving factors: Does rest or nitroglycerin relieve it?
- Associated symptoms: Arm/jaw radiation, dyspnea, diaphoresis
- Patient risk factors: Age, cardiac risk factors, prior CAD
- Duration: Acute onset or change in pattern versus chronic stable symptoms
A focused history directly from the patient is the most important basis for determining presence or absence of myocardial ischemia 1, and the diagnosis may require objective data beyond history alone, particularly when symptoms are less classic.
One case series documented stroke patients who presented with chest "burning" that mimicked cardiac ischemia, described as "burning," "hot feeling," or "tightness" 2, highlighting that burning sensations can arise from non-cardiac neurological causes as well—another reason to pursue objective cardiac evaluation when clinical suspicion exists.