Panic Attacks and Heart Attacks Can Feel Eerily Similar—Here’s How To Tell the Difference

The fact is, it can be hard to tell the difference between a panic attack and something more, like a heart attack. "The symptoms of panic attacks and heart attacks heavily overlap, and it's pretty common for people having panic attacks to fear they're having a heart attack, especially if it's their first panic attack," says Kiki Fehling, PhD, a licensed psychologist in Boston, Massachusetts.

Fehling should know. She actually had a heart attack that she initially mistook for a panic attack. "I only knew something was seriously wrong when my symptoms did not subside even after practicing several anxiety-reducing coping skills," she explains. (Thankfully, she received help in time and was successfully treated.)

Bottom line: If a mental health professional can get the two confused, anyone can. Fortunately, with the knowledge and tools to respond to both, you can tell the difference and get the help you need.

Here, learn more about the difference between heart attacks vs. panic attacks, and treatment for both.

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What are the signs of a panic attack?

For some people, one of the first signs they're anxious is a pounding heart and chest pain or discomfort. They may even feel like their heart is racing. This can cause worry that there's something wrong with your heart, which creates more fear, and ends up making symptoms worse, says Ileana Piña, MD, a cardiologist with Jefferson Health in Philadelphia and a member of the American Heart Association's National Hispanic Latino Cardiovascular Collaborative.

The below are common panic attack symptoms. They aren't life-threatening, and can cause other symptoms like the following, per the National Institute of Mental Health (NIMH):

• Sweating
• Chills
• Trembling
• Trouble breathing
• Dizziness
• Weakness
• Numbness or tingling
• Nausea or stomach cramps

Many of these symptoms can strike during a heart attack, too, says Dr. Piña. And in that case, they could be deadly. "So we always recommend that if you're uncertain, the best thing to do is to go to the ER," she adds.

How long do panic attacks typically last?

Panic attacks can feel like a tsunami. They often hit quickly without much warning and can ease up almost as fast. "Physical symptoms usually peak and subside within 10 minutes," Fehling says.

Chest pain from a heart attack, on the other hand, might ease up for a short period. But it'll keep coming back until you're treated, per the American Heart Association (AHA). It also tends to get worse as you exert yourself.

"Physical symptoms of a panic attack usually peak and subside within 10 minutes." –Kiki Fehling, PhD, psychologist

What are the signs of a heart attack?

According to the AHA, the most common signs of a heart attack are:

• Chest pain that starts in the center of your chest that can also feel like pressure, squeezing, or fullness ("It often feels like an elephant sitting on your chest," says Dr. Piña)
• Pain that radiates out elsewhere, including one or both arms, your back, neck, jaw, or stomach
• Shortness of breath
• Cold sweats
• Nausea
• Dizziness or lightheadedness

Chest pain is the most common heart attack symptom for most people. But women are more likely to have other red flags like nausea or fatigue, which could get chalked up to something else. "Women's symptoms tend to get written off as being too emotional," says Dr. Piña. "Their symptoms also sometimes get attributed to indigestion or a pulled muscle instead," she adds.

How to tell the difference between a heart attack and a panic attack

To be honest, it's not always easy (or entirely possible) to tell the difference between a panic attack and heart attack. "[Both] can overlap so much that even doctors cannot tell the difference without running medical tests," Fehling says. "So if someone has concerning symptoms it's better to be safe and get evaluated at the ER."

That said, there are clues you can pick up on, per Fehling and Dr. Piña:

• Severity of chest pain: Chest pain from a heart attack tends to hit harder and is more noticeable after you've exerted yourself, while chest pain from a panic attack isn't affected by your physical activity level. "If sitting and doing nothing makes it better, it could be your heart," says Dr. Piña.
• Pain location: Where you feel the pain can factor in, too. While both panic attacks and heart attacks can cause pain in the center of your chest, it may radiate outwards to your arm, back, shoulder, or jaw during a heart attack, per the Cleveland Clinic. That won't happen during a panic attack though.
• Length of time: Keep in mind that you should start to feel better within 10 minutes or so after a panic attack strikes, but heart attack symptoms won't go away (and may get worse) until they're treated.

Another thing to keep in mind: While emotional stress is more likely to trigger a panic attack, over time, anxiety and stress can raise your heart attack risk, too. People with depression may be less likely to make heart-healthy choices, and in general, mental health can have a physiological impact on a person's body, per the American Heart Association.

Treatment for panic attacks

"Panic attacks are very common and not dangerous," Fehling says. And if it only happens once, you don't necessarily need to get treatment. But frequent or regular panic attacks could be a sign of a certain type of anxiety called panic disorder, per the NIMH.

A panic disorder can feel debilitating and interfere with your everyday life, so it's important to reach out for help from a licensed mental health professional. Therapists will often use cognitive behavioral therapy (CBT) as the go-to approach.

"CBT helps people overcome panic by teaching them coping skills and helping them better understand the relationship between their symptoms, emotions, thoughts, and behaviors," Fehling says. "Most people who receive CBT for panic disorder remain panic-free for years after therapy," she adds. Other types of therapy for anxiety could include EMDR or a trauma therapy called brainspotting.

There are also certain anxiety and antidepressant medications that may be helpful in treating your panic disorder, per the Mayo Clinic. Talk to your doctor about these options and whether you'd be a good candidate for them.

If you're in the middle of a panic attack? Trying methods like deep breathing, mindfulness, counting out loud, or reciting positive affirmations can help shorten or stop it.

Treatment for heart attacks

Heart attacks happen when a blockage in one or more of your heart's arteries reduces or stops blood flow to the heart. This lack of blood flow deprives your heart of oxygen, which can cause part of the heart muscle to die, per the Mayo Clinic.

The only way to resolve this is with emergency treatment to remove the blockage and get a regular amount of blood flowing back to the heart. This can be done with heart medications to dissolve the clot or via surgery, per the AHA.

It's also important to protect your heart from future heart attacks with a variety of lifestyle changes, including the following, per the Mayo Clinic:

• Eating a balanced diet filled with heart-healthy foods
• Getting plenty of exercise
• Quitting smoking and limiting alcohol intake
• Reducing stress
• Maintaining a healthy weight for your body size and shape
• Managing underlying conditions like high blood pressure and diabetes
• Taking medication as prescribed
• Going to the doctor regularly for checkups

What to do if you have a heart attack

If you or someone you know thinks they are having a heart attack, call 911 immediately and get to the nearest ER. "It's so much better to get to the hospital where they can help differentiate your symptoms," says Dr. Piña. "You don't want to be sitting on a bad event that could cost you your life," she adds.

While you're waiting for an ambulance, follow any instructions from the 911 operator, which may include taking aspirin or nitroglycerin (if prescribed), and starting CPR or using a defibrillator, if you called on behalf of someone having a heart attack, per the Mayo Clinic.

When to see a doctor

Frequent panic attacks can take a toll on both your mental and physical health. So it's a good idea to give your doctor a heads up, even if you've only had one. Together you can figure out if your symptoms are anxiety-related and decide if it's worth talking with a mental health professional.

FAQ

Why does your heart race at night?

Your heart may race at night from stress, anxiety, or depression, says Fehling. Some people can also get nocturnal panic attacks, which can stir you from your sleep (and have no obvious trigger), per the Mayo Clinic.

Nighttime heart palpitations can also happen from drinking caffeine or alcohol before bed. In some cases, they could be driven by an underlying health condition like a thyroid disorder or heart disease, per the Cleveland Clinic. So if the problem is happening regularly, it's a good idea to get it checked out.

What are the different types of panic attacks?

Mental health experts categorize panic attacks into two main types. Cued panic attacks hit after you've been exposed to a frightening or triggering situation, according to the American Psychological Association. You might have one, for instance, if you have to give a speech and are terrified of public speaking. Sometimes just thinking about a trigger can cue up a panic attack.

Un-cued or unexpected panic attacks, on the other hand, feel like they hit out of the blue and have no known trigger, the APA says. They can happen during the day or at night.

Both types can be treated with talk therapy, medication, or a combination of the two.

How can you rule out a heart attack at home?

Unfortunately, you can't. Chest pain can have a wide range of possible causes, but the only way to confirm that it's not from a heart attack is by going to the hospital. So if you're not sure what you're dealing with, don't take a chance. Call 911 and go to the ER as soon as possible.

—reviewed by Jennifer Gilbert, MD, MPH