Chest aching. Racing heart. Shortness of breath. Dread. These symptoms could be signs of a non-life-threatening panic attack, or they could indicate a deadly heart attack.
The two medical conditions share a frighteningly similar playbook, but confusing them could cost you precious time.
Roughly a quarter of people arriving to the emergency department with those symptoms, believing they are experiencing a deadly heart attack, are actually suffering from a severe anxiety attack.
But the reverse is also true. Many people, especially women who are more likely to experience atypical symptoms, are misdiagnosed by doctors who tell them their symptoms are just anxiety. This mistake can be fatal.
‘Panic attack symptoms and heart attack symptoms overlap so significantly that even ER physicians often can’t tell them apart without medical testing,’ Kiki Fehling, a licensed psychologist based in Massachusetts, told the Daily Mail.
The chest discomfort from a panic attack tends to be sharp, stabbing or fleeting, and it usually stays confined to a small area. It hits suddenly, often with little warning, due to stress, fear or racing thoughts. Your hands may get clammy, your limbs may tremble, and the pain is typically short-lived, lasting just a few minutes.
A heart attack feels different. The pain is pressure or squeezing — many describe it as an elephant sitting on their chest. It often radiates outward, spreading through the chest and around to the back, up the jaw, and down one or both arms.
Heart attacks may follow days of subtle warning signs like unusual fatigue or indigestion. They are often triggered by physical exertion, sudden anger or distressing news. The pain persists or comes in waves, with shortness of breath, cold sweats, nausea, and lightheadedness.
Panic attack chest pain is often sharp, stabbing, or brief, confined to a small area. It strikes suddenly — triggered by stress, fear or racing thoughts — and usually lasts only a few minutes, often with clammy hands and trembling limbs (stock)
When the heart is damaged or struggling, the body interprets that as a crisis and dumps adrenaline into the system, just as it does during a panic attack.
In the instance of a panic attack, a perceived psychological threat causes the brain to flood the body with adrenaline and stress hormones.
‘Panic attacks feel terrifying because the body is genuinely going through a survival response,’ Dr Chloë Bean, a licensed trauma and anxiety therapist, told the Daily Mail.
‘From a somatic perspective, it can feel like the nervous system has the gas and brake pressed at the same time, which is why people feel chest tightness, dizziness, shortness of breath, sweating, a falling and spinning sensation, or heart racing all at once.’
In a heart attack, when the heart muscle is starved of oxygen due to blocked blood flow, a very real physiological threat causes the body to release the same stress hormones.
The symptoms panic and heart attacks produce can be nearly identical. Both cause chest discomfort, shallow breathing or difficulty breathing, profuse cold sweat, and lightheadedness.
However, a panic attack is not deadly. Meanwhile, about 805,000 Americans suffer a heart attack each year and roughly 80,000 die from it.
Approximately 11 percent of American adults experience a panic attack in any given year. Only about two percent to three percent of Americans have ‘panic disorder,’ a condition characterized by recurrent, unexpected attacks.
Dr Chloë Bean, a licensed trauma and anxiety therapist, told the Daily Mail that panic attacks feel so scary because your body is genuinely in survival mode. Somatically, it’s like your nervous system is hitting the gas and brake at once
A heart attack feels like pressure or squeezing — often described as an elephant on the chest. The pain radiates to the back, jaw or one or both arms (stock)
‘Panic attacks and heart attacks can feel very similar in the moment, which is why people shouldn’t try to self-diagnose under pressure,’ said Dr Clint Salo, a board-certified psychiatrist who regularly works with patients experiencing panic attacks and acute anxiety symptoms.
He added: ‘Panic tends to come on quickly and peak within minutes, often with a sense of impending doom or loss of control,’
‘Heart-related pain is more likely to feel like pressure or heaviness and may build or persist.’
A heart attack is usually due to atherosclerosis, the slow buildup of fat, cholesterol, and calcium that form plaques lining artery walls, which then become stiff and hard.
Unstable plaque can rupture, triggering a massive blood clot that blocks oxygenated blood from reaching the heart.
Salo said: ‘From a safety standpoint, if someone is experiencing chest pain for the first time, or anything that feels different than what they’ve had before, they should treat it as a medical issue and get evaluated. It’s always better to rule out something serious than assume it’s anxiety.’
Women may experience a different slate of symptoms entirely, including nausea, vomiting, profound fatigue, pain in the shoulders, anxiety and dizziness.
What are really heart attacks are often dismissed as anxiety or panic attacks. When a man has a heart attack, it often looks like what is portrayed in movies — grimacing, clutching of the chest, toppling over.
Panic and heart attack symptoms overlap so much that even ER doctors can’t tell them apart without medical tests, according to Kiki Fehling, a licensed psychologist in Massachusetts
But a woman’s symptoms are often subtle and not as easily identified. In fact, roughly 42 percent of women suffering from a heart attack do not experience chest pain and about 30 percent of women having a heart attack have no discernible symptoms.
This leads to more women dying.
The 2012 JAMA study that found 42 percent of women do not experience chest pain also reported that the figure for men was 31 percent. Fifteen percent of women died in the hospital compared to 10 percent of men.
Making matters more complicated, anxiety is not only a condition that mimics heart attacks; it is also a known risk factor for them.
Anxiety itself is a risk factor for coronary artery disease, the leading cause of heart attacks. A 2010 study of nearly 250,000 patients found that having anxiety led to a 26 percent increase in CAD.
If you have chest pain for the first time—or anything that feels different—get it checked out. Better to rule out something serious than assume it’s anxiety, according to Dr Clint Salo, a board-certified psychiatrist
Dr Una McCann, director of the Anxiety Disorders Program at Johns Hopkins Bayview Medical Center, said: ‘It’s my view and my personal clinical experience that anxiety disorders can play a major role in heart disease.
‘I believe that a really careful look at anxiety would reveal the ways it can severely impact heart disease, both as a contributing factor and as an obstacle in recovery.’
Managing anxiety helps protect against heart attacks, along with regular exercise and a diet rich in leafy greens, berries, nuts, legumes, fish, and healthy fats.
A heart-healthy diet also lowers anxiety by stabilizing blood sugar, reducing inflammation and supporting the gut-brain axis. About 95 percent of serotonin receptors are in the gut, so diet directly affects mood.
But addressing panic attacks and panic disorder — an anxiety disorder characterized by recurrent, unexpected panic attacks — takes more than just a healthy diet.
Mental health professionals believe the best place to start is cognitive behavioral therapy, commonly referred to as talk therapy.
Fehling said: ‘For people who regularly struggle with anxiety but have been medically cleared, cognitive behavior therapy [CBT] is the gold standard, evidence-based treatment.
‘Finding a CBT therapist who specializes in panic or medical anxiety can be immensely helpful and even life-changing.’
When panic attacks, the best approach is to do the unexpected: let go of control and let the attack unfold on its own. It also helps to remind yourself that panic attacks aren’t life-threatening — they’re simply your body’s natural, harmless response. No one has ever died from a panic attack.
