How can you tell the difference between anxiety and a heart attack

If you experience rapid breathing, racing heart, and a funny feeling in your chest, you may be wondering if you're having a heart attack or a panic attack. Since they share some symptoms, it can be difficult to distinguish the two. To add to the confusion, one mark of a panic attack is a concern that you are having a heart attack or dying.

This article discusses the symptoms of panic attacks and heart attacks, ways to tell the difference, and when to seek medical attention.

Heart Attack

A heart attack occurs when a blockage impairs blood flow in the arteries that feed the heart. The most common symptom is chest pressure or discomfort. However, additional symptoms like fatigue, nausea, lightheadedness, and shortness of breath can occur, especially in women.

The following are symptoms associated with heart attacks:

• Chest discomfort beneath the breastbone
• Discomfort radiating to the neck, jaw, or upper arm
• Shortness of breath
• Lightheadedness
• Fatigue
• Feeling of doom or dying
• Nausea
• Palpitations
• Sweating

Risk Factors for Heart Attack

Some risk factors for heart attack include:

• Smoking
• High cholesterol
• High blood pressure
• Diabetes
• Sedentary lifestyle

History of angina, or heart pain due to lack of enough blood flow to the heart muscle, is a very concerning symptom that can be the sign of a blocked coronary artery. It should be evaluated by a physician right away.

Panic Attack

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), panic attacks are a sudden feeling of intense fear and discomfort that subsides after a brief period of time. They include four or more of the following symptoms:

• Intense fear and racing thoughts
• Feeling of losing control
• Fear of dying
• Feeling of detachment from surroundings
• Racing heart or palpitations
• Chest discomfort
• Choking sensation
• Nausea
• Sweating
• Trembling
• Shortness of breath or rapid breathing
• Numbness or tingling
• Feeling hot or cold
• Dizziness or lightheadedness

Panic disorder is diagnosed in people who experience recurring episodes of panic attacks that cause distress and impact their life.

Differences

Location and Characterization of Pain

With a heart attack, pain is classically felt below the breastbone as a dull pressure. It may radiate up to the neck and jaw or down the left arm. It is a vague pain you cannot specifically locate with the tip of your finger. Sharp pain or pain that you can point to with a finger is unlikely to be from the heart.

Panic attacks, on the other hand, may cause chest pain with a sharp or stabbing sensation, or a choking sensation in the throat.

Never Ignore Chest Pain

Never ignore chest discomfort or assume it is from a panic attack, particularly if you have never been diagnosed with panic attacks.

Associated Symptoms

Both heart attacks and panic attacks can share the following associated symptoms, which can make them difficult to distinguish:

• Shortness of breath
• Nausea
• Lightheadedness
• Sweating
• Feelings of impending doom

Heart attacks may also be accompanied by fatigue, fainting, or loss of consciousness.

Panic attacks, on the other hand, are characterized by racing heart, racing thoughts, trembling, tingling or numbness, and a choking sensation.

Duration of Symptoms

Angina, or heart pain caused by the heart not getting enough blood (such as when there is a blockage of a coronary artery), lasts longer than a few minutes and may come and go. It may be brought on or worsened by physical exertion.

A heart attack can also occur suddenly with symptoms that may persist for hours or until the blocked artery is treated.

During a panic attack, on the other hand, symptoms typically peak in intensity after about 10 minutes, and subside after half an hour.

Triggers

Any chest discomfort that is triggered by exertion should be taken very seriously, since this can be a sign of a blockage in a coronary artery. However, a heart attack can also occur at rest without warning or during physical exertion.

Panic attacks can start randomly or be triggered by psychological distress. For example, some people experience panic attacks out of the blue and others may have panic attack symptoms when faced with a phobia, like claustrophobia or a fear of heights.

Prevention

Prevention of heart attack includes controlling risk factors like high blood pressure and high cholesterol, avoiding cigarette smoking and alcohol, eating a healthy diet, and living an active lifestyle.

Trigger signs for heart attacks include:

• Exertional chest discomfort
• Exertional shortness of breath
  
• Stress brought on by emotional or mental health issues
• Any of the heart attack symptoms previously discussed

Prevention of panic attacks includes attention to mental health. Controlling stress and anxiety, talk therapy, exercise, and medications can all help prevent recurring panic attacks.

Trigger signs for panic attacks include:

• Feeling extremely anxious or stressed
• Racing thoughts that feel out of control
• Any of the panic attack symptoms previously discussed

When to Seek Medical Attention

If you ever question if you are having a heart attack, seek medical attention immediately. Chest pain can be a sign of a serious heart attack, and it is never worth taking a chance on your health or your life.

Since panic attacks can be so difficult to distinguish from other more serious problems, the first episode of a suspected panic attack should prompt you to seek medical attention.

People who have been diagnosed with panic disorder and have recurring panic attacks will become familiar with the symptom, and can be reassured that the symptoms will pass with time.

Summary

While heart attacks and panic attacks share some common symptoms, a few differences and warning signs can help distinguish them, including the location of pain and the duration of symptoms. Medical evaluation is the best way to determine the cause. Always seek medical attention for any chest discomfort.

A Word From Verywell

It's normal to have anxiety over chest pain. Never ignore chest discomfort, because it is the most common sign of a heart attack, which can be serious and life-threatening. Any of the signs of panic attacks or heart attacks should be discussed with a healthcare provider who can perform necessary tests to rule out other disorders and develop a treatment plan.

Frequently Asked Questions

• Can you die from a panic attack?

  A panic attack will not kill you, but it can certainly make you feel like something very serious is going on. Panic attacks activate the fight or flight response of the nervous system, putting you on high alert. If you are experiencing a panic attack, try to relax with deep breaths, and remember that panic attack symptoms are a normal response to the body's alert system.

• Can a panic attack cause a heart attack?

  A panic attack does not cause heart attacks from blockages in the heart's arteries. By definition, panic attacks resolve within a discrete period of time. If symptoms continue, then a heart attack may have been the diagnosis all along.

  On the other hand, there is a syndrome called stress-induced cardiomyopathy, also known as Takotsubo cardiomyopathy or "broken heart syndrome" in which an acute stressful event triggers a stress reaction in the heart. Classically, this happens with a distressful and unexpected event, like hearing news of a loved one's death.

• How do you help someone who is having a panic attack?

  Be present with the person experiencing a panic attack and instruct them to take deep and slow breaths. If this is the first time the person is experiencing symptoms of a panic attack, it's best to get medical help, since the symptoms may be from something more serious like a heart attack. If the person has no alarming symptoms and has had panic attacks before, provide reassurance and remain until the symptoms improve. Offer to accompany the person to a more private setting and find a place to rest.

• How long does a panic attack last?

  When having a panic attack, you might feel like the symptoms will never end, but typically the symptoms will peak after 10 minutes and start to improve. Panic attacks generally resolve after half an hour.

• What should you do after a panic attack?

  First, reassure yourself that symptoms from a panic attack are a part of the body's normal response to a threat. Take some time to relax and practice deep breathing. Do activities that help you relax, like yoga, reading, or taking a bath. When you are feeling calm and rested, think back to what may have triggered the panic attack. Sometimes it may be a specific trigger, and other times it may be chronic levels of stress and anxiety. Talk therapy can be very helpful in establishing healthy ways to cope with stress and anxiety.

• How many heart beats per minute indicates a heart attack?

  There is no specific heart rate that suggests a heart attack. In fact, during a heart attack, the heart rate may be slow, normal, or fast. Your heart responds to signals from the body to increase the heart rate when appropriate. During exercise and when the fight or flight response is activated, as in a panic attack, the heart will beat faster. This is normal and expected.

• How long does a heart attack last?

  When a heart attack is due to an unstable blockage in the coronary arteries, symptoms may be intermittent or "stuttering" or continue for hours until the blocked artery is treated.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

By Angela Ryan Lee, MD
Angela Ryan Lee, MD, is board-certified in cardiovascular diseases and internal medicine. She is a fellow of the American College of Cardiology and holds board certifications from the American Society of Nuclear Cardiology and the National Board of Echocardiography. She completed undergraduate studies at the University of Virginia with a B.S. in Biology, medical school at Jefferson Medical College, and internal medicine residency and cardiovascular diseases fellowship at the George Washington University Hospital. Her professional interests include preventive cardiology, medical journalism, and health policy.

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