Panic Attack vs Heart Attack: Differences, Signs, and Treatments

Chest pain anxiety: Overview

Panic attacks are spontaneous episodes of intense fear that can last for several minutes up to an hour. People experiencing a panic attack often go to the emergency room with chest pain or dyspnea (difficulty breathing) because they’re scared they’re having a heart attack. Panic attacks have some crossover symptoms with heart attacks, and it’s easy to confuse the two. This is known as chest pain anxiety. During a panic attack, you might have feelings of impending doom, the urge to flee or escape, or fear you’re dying from suffocation or a heart attack.

There are other medical conditions that cause anxiety as a primary symptom and also include some of the symptoms of a panic attack, including:

• Myocardial infarction and angina, causing palpitations and chest pain
• Mitral valve prolapse
• Hypoglycemia
• Hyperthyroidism, causing palpitations and/or tachycardia
• Asthma, causing wheezing and difficulty breathing
• Cardiac dysrhythmias, causing fainting, heart palpitations, and difficulty breathing
• Transient ischemic attacks 
• Pheochromocytoma, causing hypertension, headache, and sweating
• Pulmonary embolism, causing chest pain and/or difficulty breathing
• Hypoparathyroidism, causing muscle cramps and/or tingling and numbness
• Seizure disorders

About 30 percent of people who experience chest pain but have no (or minimal) heart disease are diagnosed with panic disorder. Having a panic attack can often result in hyperventilation, which can, in turn, lead to chest pain and even electrocardiogram changes.

What’s the difference between a panic attack and a heart attack?

For someone experiencing pain and fear, it can be hard to figure out the difference between a panic attack and a heart attack. The two share some overlapping symptoms, but they are entirely different. 

A panic attack is characterized by a sudden, intense fear of losing control or disaster, even though there is no real danger around. Panic attacks often include strong physical reactions. A panic attack itself isn’t life-threatening, but people with panic disorder experience recurrent panic attacks and often live in fear of when their next episode will occur. 

A heart attack, also called a myocardial infarction, is when the flow of blood to the heart is blocked. Blockages can happen when cholesterol, fat, and other substances build up and form a plaque in the coronary arteries. The plaque can harden over time, break away, and form a clot. This blockage can interrupt blood flow to the heart and damage or destroy part of the heart muscle. A heart attack is a medical emergency and can be fatal if not treated in time. 

Panic attack vs heart attack: Symptoms

Symptoms of a panic attack

During a panic attack, a person may experience a combination of any of these symptoms:

• Sweating
• Trembling 
• Heart palpitations and/or rapid heart rate
• Chest pain
• Shortness of breath 
• Smothering sensations
• Feeling dizzy
• Feeling of choking
• Chills or hot flashes
• Nausea
• Abdominal pain
• Numbness
• Feeling detached
• Fear of losing control or dying

The symptoms of a panic attack can be quite strong, and many people mistakenly believe they’re having a heart attack or another life-threatening illness. Panic attacks can be either expected (a response to a feared object or situation) or unexpected (for no apparent reason). Panic attacks can occur in conjunction with other mental health conditions such as post-traumatic stress disorder or depression. 

Panic disorder is when a person experiences recurrent panic attacks and occasionally severe psychological distress, fearing their next attack.

Symptoms of a heart attack

Common heart attack symptoms are:

• Shortness of breath
• Pressure, pain, tightness, or a squeezing sensation behind the chest and pain in the left arm that may spread to the neck, jaws, or back
• Nausea, indigestion, abdominal pain, or heartburn
• Cold sweat
• Feeling dizzy or light-headed
• Fatigue

Heart attack symptoms can be significantly different from person to person. Pain can range from mild to severe. Some people experience no symptoms and are surprised to find out they had a heart attack. Heart attacks without any warning signs or symptoms are called silent heart attacks. Most people have some warning signs. 

The more symptoms a person is experiencing, the more likely it is that they’re having a heart attack. Individuals may experience symptoms hours, days, or weeks in advance. The earliest and most common warning sign is recurring chest pain or pressure (angina) that’s brought on by exertion and goes away with rest. Patients who experience no chest pain warning signs are typically female, older, or diabetic. 

If you’ve had a heart attack in the past, it doesn’t mean you’ll experience the same symptoms if you have another heart attack in the future. 

Some important heart attack facts to remember include:

• Symptoms can come and go for several hours. 
• Women’s heart attack symptoms are slightly different than men’s. Women tend to experience shortness of breath, nausea, vomiting, unusual tiredness, and pain in the jaw, shoulder, and back.

Panic attack vs heart attack: Causes

What causes a panic attack?

It’s unclear what causes panic attacks or panic disorder, but certain factors may play a role:

• Major stress
• Genetics
• Temperament
• Certain changes in brain function

Panic attacks can come on suddenly, but they’re usually triggered by specific situations such as life stress.

What causes a heart attack?

There are two main causes of heart attacks: coronary heart disease and coronary artery spasm. 

Coronary heart disease

Heart attacks occur when oxygen-rich blood can’t make it to the heart muscle, depriving the heart of oxygen. Most heart attacks are a result of ischemic heart disease, which is when plaque builds up inside of the coronary arteries. This buildup of plaque in the arteries is known as atherosclerosis and can take years to accumulate. 

At some point, a piece of the plaque can break open inside the artery, causing a clot to form and block most or all blood flow through a coronary artery. 

Without quick treatment, the portion of the heart muscle being fed by that blocked artery begins to die. The healthy heart tissue is then replaced with scar tissue. Unfortunately, this heart damage isn’t always apparent and can cause serious issues. 

Coronary artery spasm

A less frequent type of heart attack is a severe tightening of the coronary artery. This spasm cuts off blood flow and can occur in coronary arteries that aren’t affected by atherosclerosis. It’s unclear what causes a coronary artery to spasm, but it may be related to:

• Use of certain drugs such as cocaine
• Emotional stress
• Exposure to extreme cold
• Smoking

Panic attack vs heart attack: Management

Ways to manage a panic attack

Stress management techniques, such as meditation and breathing exercises, can help you flow through an attack. Some studies show that many people who have panic disorder have slightly higher-than-average breathing rates. Learning how to slow your breathing can help control panic attacks and prevent future ones. 

Coping statements, such as “I’m not dying; I’m feeling anxious,” can help you get through a panic attack. Once breathing is under control, try to distract yourself to shift your focus. 

Panic disorder is typically treated with medication, psychotherapy, or a combination of the two. Talk with your health care provider about what’s best for you. 

The most popular form of psychotherapy treatment for panic disorder is cognitive behavioral therapy (CBT). CBT teaches people different ways of thinking and how to react to their panic attacks.

Ways to manage a heart attack

A heart attack is a medical emergency. It’s critical to call emergency services as soon as you suspect a heart attack. While waiting for the ambulance to arrive, it may be helpful to chew a tablet of aspirin (300 milligrams) as long as you’re not allergic to aspirin. Aspirin can thin the blood and possibly improve blood flow to the heart. 

Treatment at the hospital will depend on the severity of the heart attack. The two treatment options are:

• Thrombolytic medicine to dissolve blood clots
• A nonsurgical procedure called percutaneous coronary intervention that opens narrowed or blocked arteries 

When to see a health care provider

Panic attacks are not dangerous on their own, but you should still seek medical help as soon as possible. It can be challenging to treat panic attacks on your own, and they can get worse without treatment. Additionally, panic attack symptoms can be similar to other medical condition symptoms, so your health care provider may need to rule out other health concerns. 

For heart attacks, immediate action is necessary. Early treatment can limit or prevent damage to the heart muscle. Call emergency services immediately if you suspect a heart attack. A heart attack can be fatal if help isn’t received in time.

Top things to remember

It can be complicated to distinguish between a heart attack and a panic attack in a moment of pain and fear. You might experience chest tightness anxiety or chest pain anxiety when you begin experiencing certain symptoms. Understanding the symptoms of both panic attacks and heart attacks allows you to take the proper course of action for each.