Heart Attack vs. Panic Attack: Key Differences, Symptoms, and What to Do
Recognizing subtle signs can help you respond calmly and reach safety when pain strikes.
Heart Attack vs. Panic Attack: Understanding the Differences
Sudden chest pain. Shortness of breath. Your heart races, fear takes over, and you might wonder—am I having a heart attack or just a panic attack? Both conditions are alarming and share overlapping symptoms, but knowing the difference is vital for your safety and peace of mind. This guide breaks down the core differences between heart attacks and panic attacks, reviews their symptoms side by side, and offers practical steps for what to do if you experience these distressing sensations.
Why Do Heart Attacks and Panic Attacks Feel Similar?
Both heart attacks and panic attacks can come on without warning and provoke intense physical sensations that are difficult to ignore. The key similarity is their effect on the cardiovascular system—each can cause chest pain, palpitations, and a sense of impending doom. But the underlying causes are very different:
- Panic attacks are triggered by the body’s stress response, causing an intense surge of adrenaline and activating the fight-or-flight response, even when there’s no actual danger.
- Heart attacks happen when blood flow to the heart is blocked—usually by a blood clot—depriving part of the heart muscle of oxygen and causing tissue damage.
Common Causes
- Panic attacks: Sudden stress, anxiety, or no identifiable trigger at all. They can happen during rest or sleep.
- Heart attacks: Physical exertion, blocked arteries (coronary artery disease), or heightened cardiac demand (such as during physical activity in someone with heart disease).
Key Symptoms: Side-by-Side Comparison
| Symptoms | Panic Attack | Heart Attack |
|---|---|---|
| Chest pain or discomfort | Yes (often sharp, fleeting, or stabbing) | Yes (often squeezing, pressure-like, heavy) |
| Heart palpitations (rapid heartbeat) | Yes | Sometimes |
| Shortness of breath | Yes | Yes |
| Cold sweat | Sometimes | Yes (classic sign) |
| Feeling of impending doom | Yes | Sometimes |
| Tingling or numbness | Yes (more in hands, feet, mouth) | Possibly (more in left arm or jaw) |
| Dizziness or lightheadedness | Yes | Yes |
| Trembling or shaking | Yes | Rare |
| Nausea | Sometimes | Yes |
| Feeling of choking | Yes | No |
| Pain radiating to arm/jaw/back | No | Yes |
How to Tell the Difference: Main Distinguishing Features
1. Onset and Triggers
- Panic attack: Usually not related to physical activity. May start suddenly, often during rest or after emotional stress.
- Heart attack: Often triggered by exertion or physical activity. Can also occur at rest, especially in people with heart disease.
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2. Nature of Chest Pain
- Panic attack: Sharp, stabbing, or fleeting chest pain; not usually worse with exertion; may last 10–20 minutes and peak within minutes.
- Heart attack: Dull, squeezing, heavy, or pressure in chest; may worsen with activity or not let up; can radiate to the left arm, neck, back, or jaw; usually lasts longer than 20 minutes and may worsen.
3. Other Symptoms
- Panic attack: Feelings of unreality (derealization), choking, tingling in hands/feet, intense fear of losing control.
- Heart attack: Nausea, vomiting, cold sweats, sense of crushing weight in the chest. In women, symptoms can be atypical (like fatigue, indigestion, or mild discomfort).
4. Duration
- Panic attack: Symptoms peak within 10 minutes and often resolve within 20–30 minutes.
- Heart attack: Symptoms may last longer and intensify over time; do not resolve without treatment.
5. Risk Factors
- Panic attack: More common in younger adults, people under stress, or those with anxiety disorders.
- Heart attack: More common in individuals with risk factors like age over 50, high blood pressure, diabetes, smoking, high cholesterol, obesity, family history of heart disease.
Can a Panic Attack Cause a Heart Attack?
By itself, a single panic attack is unlikely to trigger a heart attack in a healthy person. However, chronic, severe stress or anxiety can increase cardiac risk, especially in those with existing heart disease or multiple risk factors. Rarely, extreme emotional stress triggers a temporary heart condition called stress-induced cardiomyopathy or “broken heart syndrome”—but this is an exception, not the rule. If you have underlying heart disease, managing both your cardiac and mental health is crucial.
When to Seek Emergency Care
- If you have chest pain that is severe, lasts longer than a few minutes, or is accompanied by shortness of breath, sweating, weakness, nausea, or pain radiating to your arm, neck, jaw, or back, call 911 immediately.
- If in doubt, always err on the side of caution—emergency teams can quickly test for heart attack and rule it out.
- Remember: Panic attacks are not life-threatening. Heart attacks can be—and require immediate action.
How Doctors Diagnose the Cause
In the emergency department or doctor’s office, your medical team will:
- Take a careful history and ask about symptom onset, duration, nature of chest pain, risk factors, and previous episodes.
- Check vital signs, oxygen levels, and perform a physical exam.
- Run tests such as:
- Electrocardiogram (ECG/EKG): Detects heart rhythm and signs of a heart attack.
- Blood tests: Look for cardiac enzymes indicating heart muscle damage.
- Imaging: Echocardiogram or other heart tests as needed to check structure and function.
- If all tests are normal, and the context is suggestive, your provider may consider a panic attack diagnosis.
What to Do During Each Event
If You Suspect a Heart Attack
- Stop all activity and sit or lie down.
- Call 911 or your local emergency number immediately.
- Chew an aspirin (unless allergic) while waiting for emergency services—it may help reduce damage.
- Do not drive yourself to the hospital.
If You Suspect a Panic Attack (Once a Heart Issue Is Ruled Out)
- Practice slow, mindful breathing—in through the nose for 4 counts, out for 6 counts.
- Remind yourself that panic attacks, although frightening, are not life-threatening and usually pass within minutes.
- Use grounding techniques (describe your surroundings, say what you see, feel, hear, smell).
- If you have medication prescribed for anxiety or panic, take it as directed.
- Talk with someone you trust or seek medical advice if this is your first episode.
Preventing Heart Attacks and Panic Attacks
Reducing Heart Attack Risk
- Quit smoking and limit or avoid alcohol
- Exercise regularly, aiming for at least 150 minutes weekly of moderate physical activity.
- Maintain a heart-healthy diet—low in saturated fat, high in fresh fruits, vegetables, and whole grains.
- Manage chronic conditions like diabetes and high blood pressure.
- Keep cholesterol levels in check.
Managing and Preventing Panic Attacks
- Practice regular stress reduction—try meditation, yoga, tai chi, or breathing exercises.
- Engage in regular physical activity and allow for relaxation.
- Seek professional help for chronic anxiety or panic—counseling, cognitive-behavioral therapy, or medication may be needed.
- Avoid caffeine, recreational drugs, and other triggers that worsen anxiety.
Frequently Asked Questions (FAQs)
Q: Can anyone have a panic attack or heart attack?
A: Panic attacks can affect anyone but are more common among people with anxiety disorders, high stress, or trauma history. Heart attacks mainly affect those with underlying risks such as heart disease, high cholesterol, hypertension, or advanced age, though they can occasionally strike otherwise healthy individuals.
Q: Are panic attacks dangerous?
A: Panic attacks are intensely uncomfortable but not dangerous or physically life-threatening. However, frequent attacks can impair daily life and quality of living—professional treatment is recommended if they are recurrent.
Q: What types of chest pain are more likely to be a heart attack?
A: Heart attack chest pain is usually described as pressure, squeezing, or a heavy tightness that may radiate and doesn’t improve with rest or anxiety-relief techniques. If pain persists, or is associated with risk factors, seek emergency help.
Q: How do doctors rule out heart attacks in the ER?
A: Doctors use a combination of ECGs, blood tests (for cardiac biomarkers), and sometimes imaging tests to detect heart muscle damage or blockages. If all results are normal and there’s no underlying risk, a panic attack diagnosis may be made after thorough assessment.
Q: Can you have both at the same time?
A: Yes, it’s possible for someone having a heart attack to experience anxiety or panic, or for severe panic to trigger symptoms that may look like a cardiac event. Always seek prompt medical evaluation if unsure.
Final Thoughts
Both heart attacks and panic attacks can be terrifying, especially when symptoms seem identical. While panic attacks are not life-threatening, heart attacks are medical emergencies. Never ignore your symptoms—if there’s any doubt, get immediate medical attention. With information, prevention, and professional care, you can take control of your heart and mental health.
References
- https://healthmatters.nyp.org/panic-attack-or-heart-attack-how-to-tell-the-difference/
- https://www.njcardiovascular.com/blog/panic-attack-vs-heart-attack-how-to-tell-the-difference
- https://www.bidmc.org/about-bidmc/wellness-insights/heart-health/2020/01/panic-attack-vs-heart-attack
- https://www.urmc.rochester.edu/news/publications/health-matters/panic-attacks-vs-heart-attacks-understanding-the-differences
- https://www.youtube.com/watch?v=eC_Of8Fu83E
- https://www.heart.org/en/news/2022/07/13/how-to-tell-the-difference-between-a-heart-attack-and-panic-attack
- https://health.clevelandclinic.org/the-difference-between-panic-attacks-and-heart-attacks
- https://www.micnyc.com/post/panic-attack-or-heart-attack-how-to-tell-the-difference
- https://www.scripps.org/news_items/7567-heart-attack-panic-attack-anxiety-and-indigestion-what-s-the-difference
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