The album was a mixture of rockabilly and country recordings, featuring collaborations with musicians Elvis Costello, The Cramps and Rosie Flores.

[7] The album's title track was first recorded and released as a single by Martina McBride in 1994, reaching the top 25 of the American country songs chart.

[7] Dave Alvin was also featured on several of the album's tracks, providing guitar instrumentation to three songs, including "Rockabilly Fever".

Thom Jurek of AllMusic gave the project a four-star rating, citing the album's "killer collection of songs" and Jackson's vocals that were "in fine shape".

[2] Charlotte Robinson of PopMatters found that Jackson "is one of the few ’50s country/rock fusionists remaining who still tours on a regular basis and sounds just about as good as she did back in the day."

She concluded positively in review, saying, "Still, to hear Jackson, now a grandmother, capture most of the snarls and hiccups she did in the old days is a real treat.

"[11] The album also received a positive response from OffBeat magazine, who compared it to Johnny Cash's American Recordings releases.

"Heart Trouble is an excellent mix of new songs crafted to sound like the country and rockabilly standards that they join on this CD," reviewer Mike Perciaccante commented.

[1] Jon Johnson gave the album a mostly positive response, but criticized the record's rhythm section, highlighting the project's upright bass player and drummer.

[14] Following its original release, Jackson discussed the album with Country Music Television and noted she was pleased with the record's response: "All the reviews have talked about the energy the songs still have — and how I’ve still got the growl.