Heartburn is related to smoking because smoking causes sympathetic excitation of the heart and long-term smoking leads to coronary artery atherosclerosis, which can manifest as heartburn. Nicotine and other irritants or harmful substances contained in smoking cause the coronary arteries to narrow, resulting in ischemia of the heart. Patients may experience similar panic attacks due to arrhythmias and ischemia of the heart. Patients are advised to quit smoking and to have an electrocardiogram checked. If no clear ischemia is found, further improvement of ambulatory electrocardiogram and cardiac ultrasound will be performed to capture whether there is evidence of arrhythmia or cardiac ischemia. If the patient is over 45 years old and has recurrent episodes of panic, it is recommended to improve coronary CTA or coronary angiography.