A heart that feels hot may be a sign of myocardial ischemia. The most common cause of myocardial ischemia is coronary artery disease, which includes many types of angina pectoris and myocardial infarction. The typical symptoms of patients with angina are a fist-sized, palm-sized range of stuffiness and pain in the anterior precordial region of the lower and middle sternum, which can be a squeeze-like, crunch-like pain sensation, while for the hot and spicy sensation, the symptoms are not typical. Hot and spicy feeling in the heart, if it is an angina attack, can also occur in the elderly as well as in patients with diabetes. Therefore, the diagnosis of angina cannot be ruled out based on the hot and spicy feeling in the heart, and it is recommended to give cardiac enzymes, electrocardiogram, cardiac ultrasound, and coronary artery imaging to clarify the diagnosis. In addition, the diagnosis of a burning sensation in the heart needs to be differentiated from functional heart diseases and non-circulatory diseases.