Panic Attack vs. Heart Attack: How to Tell the Difference

Your heart suddenly begins racing. You feel pain in your chest and you are short of breath.

Are you having a heart attack? Or could it be a panic attack?

"Any of these symptoms can be extremely frightening," says Patricia Tung, MD, of Arrhythmia Services at Beth Israel Deaconess Medical Center.

Although they share a number of similarities, the two conditions result from very different disease processes. Panic attacks arise when stress hormones trigger the body's "fight or flight" response, often resulting in racing heart, chest pain and shortness of breath.

In the case of a heart attack, a blockage in a coronary artery may result in the same symptoms. "Chest pain, rapid heartbeat and breathlessness may result when an insufficient amount of blood reaches the heart muscle," says Tung. (See "Symptoms" below.)

One of the key distinctions between the two is that a heart attack often develops during physical exertion, whereas a panic attack can occur at rest.

A heart attack is more likely to develop when the work load of the heart increases, for example while a person is shoveling snow or running up the stairs, especially in people who do not routinely engage in physical exertion.

Another difference is duration: Panic attacks tend to gradually subside and resolve on their own within about 20 minutes. A heart attack, however, will often continue and may worsen over time.

You should always seek immediate medical attention if there's any question, says Tung. In women, heart attack symptoms may be milder and could include unusual fatigue and chest discomfort rather than chest pain. It's important not to minimize symptoms, as the situation could quickly escalate. Never hesitate to call 911.

If symptoms are determined to be a panic attack, a number of treatment options are available. These might include integrated therapies that focus on stress management and relaxation techniques such as meditation, acupuncture, yoga and tai chi.

When Your Heart Skips a Beat

Heart palpitations, in particular, can be a source of worry. "People have a heightened awareness of their own heart when they experience palpitations," says Tung. "They may feel like their heart is fluttering or thumping or has suddenly skipped a beat." Palpitations can be a symptom of a panic attack or other cases of short-term or long-term stress or can result from caffeine or certain medications. However, in some cases, palpitations are a symptom of a condition known as an arrhythmia or irregular heartbeat. "Arrhythmias, such as atrial fibrillation, are serious conditions that should not be ignored," says Tung. "If you are experiencing frequent palpitations, your physician can conduct an exam and may conduct additional tests to determine if palpitations are caused by stress or underlying heart disease." Tests might include an electrocardiogram with a Holter monitor, a portable machine worn at home for 24 to 48 hours to monitor your heartbeat during day-to-day activities.

The following are typical symptoms of heart attack and panic attack. Always contact your doctor or call 911 if you have any questions.

Heart Attack

• Squeezing pain and pressure in the chest
• Sudden onset during or following physical activity (i.e., climbing the stairs or shoveling snow)
• Pain that radiates to the arm, jaw or shoulder blades
• Pain and symptoms that get worse over time
• Shortness of breath
• Near fainting
• Sweating
• Nausea and vomiting

Panic Attack

• Increased or racing heart rate
• Sudden onset or onset during extreme stress or anxiety
• Pain that gets better over time
• Symptoms that resolve within 20 to 30 minutes
• Shortness of breath
• Sweating
• Tingling in the hands