Why You Can Trust CNET Heart Attack vs. Panic Attack: Differences and Details to Know
Until proven otherwise, chest pains need to be taken seriously. Once you've ruled out a heart problem, here's what doctors would like you to know.
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People with anxiety may already know what it's like to experience an anxiety or panic attack based on previous (scary) experiences of physical symptoms brought on by stress or another trigger (and sometimes no recognizable trigger).
According to the Cleveland Clinic, symptoms of a panic attack typically peak within 10 minutes before they start to fade, bringing symptoms such as a racing heart, hyperventilation, chest pain, nausea, intense fear or feelings of loss of control down with it. Panic attacks usually resolve within 20 or 30 minutes.
Panic attack symptoms are frustratingly similar to heart attack symptoms: both include chest pain, nausea, sweating and feelings of doom. When it comes to one overlapping symptom in particular -- chest pain -- it's best to treat it seriously and get evaluated by a medical doctor, at least the first time it presents so you can rule out an underlying heart health problem.
To be clear: Chest pains are a common symptom of people with anxiety or those who have panic attacks. Dr. Maame Yaa Yiadom, a physician, researcher and associate professor of emergency medicine at Stanford University, said that presenting to the emergency room with what turns out to be symptoms of a panic attack is "very common."
"We diagnose panic attacks far more frequently than heart attacks," Yiadom wrote in an email. "But we rarely do so without testing for a heart attack first."
We know that this might be one of the last things you want to hear when you live with anxiety. But given the prevalence of heart disease in the US, it's important to make sure your symptoms stem from anxiety and not an underlying health condition that's putting you directly at risk. Similar to how a panic attack may mimic a heart attack, some heart conditions like blocked arteries, for example, can mimic a panic attack, according to Dr. Mustali Dohadwala, a cardiologist and principal practitioner of Heartsafe. This adds to the "ton of complexity" and "ton of nuance" to the discussion of chest pain, heart attacks and panic attacks, according to Dohadwala. (Frustrating, we know.)
"If you're in doubt at all," he said, "my advice to all my patients is to go ahead and exclude an underlying heart condition at that time."
At then at some point, Dohadwala added, "we also have to consider the burden on the health care system as well," and that also includes you, your money and your time.
"It probably doesn't make sense for someone who's having a panic attack to continue to report to the ER time after time after time when they've already had an evaluation," Dohadwala said.
Still, he said, "It's important that you've gone, you've gotten an evaluation, you've been told your heart's in good shape."
Up to 11% of the US population has a panic attack each year; many of those people will have recurrent panic attacks with similar symptoms each time. It's tricky business talking about chest pains and recommendations on when to seek medical attention because the best medical advice would be to go in any time you experience chest pains or any other symptom of a heart attack, to be definitively sure of their cause and give you peace of mind each time.
So to help give you some more context, we looked at potential differences and spoke with doctors about how to manage the often conflicting information you may find online when comparing panic attacks and heart attacks. Here's what to know.
Read more: 5 Ways to Ground Yourself When You're Experiencing Anxiety
Know your risk for anxiety or panic attacks
While panic attacks may seem like they come out of the blue, they're more common in people with a history of anxiety, depression or another mental health condition.
This is not to dismiss your physical symptoms or say you can't also be experiencing an emergency medical event, but understanding how a panic attack can manifest will give you important context to take into account as you start to experience the more physical or scary symptoms of a panic attack, like a racing heart or sense of doom. It'll also give you a sense of what to compare your current symptoms to. It may also prompt you to find a treatment plan so you can start improving your overall well-being.
The flip side of this is that it may be extra important to pay attention to new symptoms like sweating palms, nausea and more if you've never experienced a panic or anxiety attack.
Know your risk for heart attack and heart disease
Men aged 45 and older and women aged 55 and up are more likely to have a heart attack than younger adults. Beyond that, there are "key risk factors" for heart disease (which includes heart attacks), according to the US Centers for Disease Control and Prevention, which are high blood pressure, high cholesterol and smoking.
People with diabetes, those who drink a lot of alcohol, people with a high BMI and those who are physically inactive and those with a less-healthy diet may also have a higher risk. You may also know you have a higher risk if you have a family history of heart disease or heart attacks.
If you have one or two of these risk factors, that doesn't mean you're definitely having a heart attack. It does mean your general risk of cardiovascular disease is higher, and it's a good idea to discuss management and prevention with your doctor.
Your doctor may also help you prepare an individual plan or checklist if you also experience panic attacks or have concerns about other health issues.
Read more: How to Survive a Heart Attack
Heart attack vs. panic attack chest pain symptoms
In addition to having a general idea of your risk for heart disease and your risk for experiencing a panic attack, there are a few different ways the chest pain or symptoms from a heart attack can differ from those of a panic attack.
The experts we spoke with cautioned that the reported symptom differences aren't significant enough, and symptoms vary too much, for this to be a definitive test of what you're experiencing.
When your symptoms begin, and end, matter
One distinction between heart attacks and panic attacks is that heart attacks often come on during physical exertion (working up a sweat from shoveling or running up the stairs, for example) because the heart has to pump a little harder.
Another distinction is how long they last. As mentioned earlier, panic attacks often peak around 10 minutes and are likely to be resolved within a half hour. Heart attack symptoms -- while they may last just a few minutes in some people -- often will include symptoms that come and go, or even last for days. Don't ignore this.
Chest pain may be different, but not in a reliable way
Most cases of heart attack chest pain, according to the CDC, are discomfort in the center or left side of the chest. It will last "more than a few minutes," and it may go away but then come back, the agency said.
According to the Cleveland Clinic, heart attack pain also may radiate to other parts of your body like your arm, jaw or neck, while panic attack pain will typically stay in the chest. Women may be more likely to experience the "less obvious" heart attack signs, like nausea and jaw or shoulder pain.
The chest pain of a heart attack is often described as an "uncomfortable pressure, squeezing, fullness or pain," per the CDC. Heart attack pain may also feel like an achy burn.
Generally speaking, anxiety chest pain tends to feel sharper and less like a tightness.
"Heart attacks can cause severe chest pain, like a 9 or 10 on the pain scale," Cleveland Clinic cardiologist Dr. Mistyann-Blue Miller, said in an article by the Clinic.
"Then later, the pain may drop to a 3 or 4 before it gets worse again," Miller said. "The pain might change, but it won't go away."
Yiadom cautioned against using the different presentations of chest pain as a differentiating factor between panic attacks and heart attacks, given the different ways people may communicate sensations or pain based on their language, as well as demographic and sex differences.
Dr. Andrew Freeman, a cardiologist with National Jewish Health in Denver, also said that because the symptoms of heart attacks present differently from person to person, it's difficult to derive much meaning from this.
"There's no one magic symptom or issue," he said. And even when it comes from stress, chest pain "needs to be taken seriously," he added, as chronic anxiety can have an impact on heart health. Living a long time with stress from anxiety may raise blood pressure over time, which increases the risk of heart disease over time. So one more reason to reach out for help if you need it.
Why anxiety makes your heart race
The "fight or flight" response that's in full gear during a panic attack can cause your heart to beat faster. While they may feel scary, heart palpitations from anxiety should pass within a few minutes or as your anxiety eases. Heart palpitations may also come on after you drink caffeine, especially if you drink more of it than you're used to.
"Symptoms of palpitations, nausea, excessive sweating, dizziness -- a sense of impending doom, even," Dohadwala said when explaining the symptoms of a panic attack. "All that's driven by fight or flight response that's generated from those natural hormones that are released by the body."
On the other hand, heart palpitations that come on suddenly with chest pain, fainting or other symptoms of a heart attack -- and you can't identify another cause, like anxiety -- shouldn't be ignored, as they could be symptoms of a heart attack or other cardiovascular event.
Bottom line: Managing your anxiety will help your heart
Say you've taken your chest pains seriously and you've had them evaluated. That's a good first step, but it's not the only step. According to Freeman, many of the daily stressors in our lives contribute equally to heart disease and to mental health conditions like panic disorder or anxiety -- high stress, lack of sleep, isolation and a sedentary lifestyle, to name just a few.
This even trickles down to the way we describe disease. "Dis-ease," he said, means "lack of ease."
"Figuring out ways to restore ease in many ways restores health," Freeman said. Addressing the sources of your symptoms, even when they're from anxiety, will help your health in more ways than one.
"At the end of the day, all you can do is your best," Freeman said. "And if you're not sure what's going on, check with someone who can help you."