Panic Attack or Heart Attack? How to Tell the Difference

Shortness of breath, chest tightness, a racing heart — are these symptoms of a panic attack or a heart attack?

Knowing your cardiovascular risk factors and history of anxiety are important to help distinguish between the two, experts say, because the symptoms can overlap. While a panic attack generally isn’t a medical emergency, when in doubt, seek immediate care, as heart attacks can present differently in each person.

“We can use tools like blood tests and electrocardiograms, along with context of the symptoms, to help rule out a heart attack,” says Dr. Joy Gelbman, a cardiologist at NewYork-Presbyterian/Weill Cornell Medical Center. “Cardiovascular risk can also increase if stress and anxiety are prolonged and severe, so it’s key to find ways to de-stress, like being outdoors, stretching, breathwork, listening to music, or meditation.”

For both conditions, prevention can make a world of difference. “Just like you want to prevent a heart attack, we should be focusing on ways we can prevent a panic attack,” says Dr. Ryan Sultan, a psychiatrist at NewYork-Presbyterian/Columbia University Irving Medical Center and director of the Mental Health Informatics Lab at Columbia University Irving Medical Center. “It’s not always easy, but getting good sleep, eating healthfully, and exercising all impact overall mind-body-spirit wellness.”

Drs. Gelbman and Sultan share more with Health Matters on the differences between a panic attack and heart attack, how the two are related, and when it’s time to seek immediate help.

What are the symptoms of a panic attack?
Dr. Sultan: Your sympathetic nervous system is so ramped up and you’re in this very heightened physiological state, but the energy isn’t being directed anywhere. It’s as if you are driving a gas-powered car but you’re pressing down on the brakes while pushing on the accelerator at the same time. There’s all this kinetic energy, but you’re frozen.

Some people have reported that they’ve had panic attacks lasting hours. But it may only be fleeting, like five to 10 minutes, depending on the individual. Some also describe it as feeling like they’re going to die — that’s how overwhelming it can be.

If you’ve had a panic attack and you have the resources to see a mental health professional, you should. Why did you have that panic attack? What other mental health conditions might you have that are contributing to it? If you’ve had multiple panic attacks in a short to medium period, I would strongly encourage an evaluation from a professional.

What are the symptoms of a heart attack?
Dr. Gelbman: It’s important to seek immediate emergency care if you have pain in the center of the chest that lasts more than a few minutes that feels like pressure or squeezing; discomfort radiating to the arm, neck, or jaw; and sudden shortness of breath. But keep in mind that for a heart attack, not everyone is going to have that feeling of an elephant sitting on their chest — especially women, who can have atypical symptoms like nausea, sweating, or just feeling like something’s off. Because of their atypical nature, women’s heart attack symptoms can be mistaken for anxiety, so it is important to be clear about symptoms and make sure that cardiac causes have been considered.

If you’re having exertional symptoms — for example, you used to be able to walk a mile and now after three blocks you’re getting chest pain, or if you used to climb a flight of stairs easily and now experience chest discomfort — that’s certainly reason for some concern. If anything feels out of the ordinary, seek medical attention.

If you’ve had panic attacks your whole life, you’ve been evaluated, and you’re having them again, it might be a panic attack. But if something changes about the attacks — the frequency, the severity, the character in some way — those would be red flags that you need to get checked.

How do doctors tell the difference between a panic attack and heart attack?
Dr. Gelbman: If someone thinks they are having a heart attack or panic attack and comes to the emergency room, it’s a matter of ruling out other causes to determine possible anxiety.

Someone can feel palpitations because of anxiety, but sometimes, certain heart rhythm problems can present as palpitations. We can do an echocardiogram to make sure the heart’s structurally normal, hook a patient up to a rhythm monitor to make sure there are no arrhythmias, and do lab tests. If results are normal, and after evaluating the context of the symptoms, we can further discuss with the patient whether it could be anxiety.

In my experience, sometimes just getting negative results for a heart attack can help relieve someone’s immediate anxiety symptoms and stop them from going down a rabbit hole of worry.

Can a panic attack cause a heart attack?
Dr. Gelbman: There’s a spectrum of what can happen to the heart from stress, based on different cardiac risk factors. The more intense the stress or anxiety, it’s likely there are more intense possibilities for cardiovascular effects, but there is no hard and fast rule. There are extreme manifestations, like a stress-induced cardiomyopathy when the heart can get transiently weakened from stress. That typically does not occur in instances where someone’s stressed about their job or finances over a long time; it’s more of an acute phenomenon, like learning sudden bad news.

Dr. Sultan: A panic attack by itself is likely not sufficient to create heart attack in an otherwise healthy individual. But I encourage patients to look at it through a lens of stacking risk factors. There are cases where people have been under excessive short-term or long-term stress, then have a cardiac event during that period due to a number of existing cardiovascular risk factors. The panic attack could be the straw that breaks the camel’s back.

How can you reduce stress and lower your risk for cardiovascular disease?
Dr. Sultan: Many factors that impact anxiety can also impact heart and overall health: How can you get a good night’s sleep and engage in relaxation techniques regularly?

For anxiety, there’s a variety of treatments ranging from mindfulness meditation and managing your intake of stimulants like caffeine, to cognitive behavioral therapy and medications like selective serotonin reuptake inhibitors (SSRIs).

Dr. Gelbman: Some risk factors for heart disease are not modifiable, such as your age or genetics, but risk factors like blood pressure, cholesterol, and sugar levels can be influenced by lifestyle factors, and stress itself is a risk factor.

If you have hypertension, you want to treat it; if you’re smoking, you should stop. If you have stress in your life, you should find ways to address that. Whether it’s asking for help or getting fresh air, seeking out even small ways to relieve your stress can be impactful.