DEAR DR. ROACH: I’m a generally healthy 73-year-old man. I recently had blood work done and was incidentally noted to have high liver tests (ALT and AST). My doctor ordered a sonogram, which said that my liver was “diffusely echogenic, consistent with fatty infiltration.” I used to have an occasional drink, but I haven’t had any alcohol for months. What should I do now?

I did recently start on a statin, and my liver tests were normal before I started on it. — R.C.

ANSWER: With abnormal liver tests and your liver sonogram, I would be concerned that you had metabolic-associated steatotic liver disease. (We used to call this nonalcoholic fatty liver disease.) It’s is a very common issue that affects 30% of the population.

Only men who habitually consume less than 2 drinks per day (for women, 1.5 drinks per day) can be considered for this disorder. People who drink more than this amount may have metabolic-dysfunction and alcohol-associated liver disease, or just alcohol-associated liver disease. We worry about these conditions because they can progress to liver fibrosis, and a few people will go on to develop cirrhosis.

In people who have fatty infiltration of the liver and abnormal test results, I recommend further evaluation with a Fib4 test. I used the information you sent me to do this (it’s just based on blood test results, all of which you already had), and the Fib4 said that you should get further evaluation. This would be with a noninvasive test called elastography (one brand name is FibroScan), which uses an ultrasound to determine your risk for fibrosis and cirrhosis.

However, your abnormal AST and ALT tests seem like they are more likely due to the statin. Mild elevations are very common and not dangerous to the liver, but I am concerned that your statin is making it seem as though you might have more advanced liver disease.

In my opinion, you should see a gastroenterologist with special expertise in liver disease. Elastography may still be a smart idea because it is possible to have liver fibrosis even with normal liver tests.

DEAR DR. ROACH: What is heartburn? Can heartburn feel like a heart attack? — A.S.Q.

ANSWER: Heartburn is a sensation of discomfort in the upper abdomen or in the lower chest that is burning in quality. Although we often tie heartburn to acid reflux, it’s impossible to be immediately sure of the underlying cause.

People who have had a heart attack generally know what it is if it occurs again, but a person who develops heartburn may not be at all sure what the cause is. I have known many patients, both women and men, who have had heart attacks that they initially attributed to heartburn.

Pain from a heart attack is highly variable. It can be the textbook crushing pain below the sternum (breastbone), but people are more likely to say it feels like pressure or tightness. Nausea and abdominal pain are common. Shortness of breath and sweating are red flag signs of a heart attack.

Heartburn from acid reflux (gastroesophageal reflux disease, or GERD) usually feels like a burning sensation that is worse when lying down. It is sometimes associated with a sour taste of acid getting all the way into the mouth. Heartburn pain is usually rapidly improved by an antacid, especially a liquid antacid.

New chest or abdominal pain that doesn’t go away in 5 minutes should be considered an emergency in people who are at risk for a heart attack. If you aren’t sure and think you might be having a heart attack, you should get emergency medical help by calling 911.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. (c) 2025 North America Syndicate Inc.All Rights Reserved