Heart Attack or Panic Attack: How to Tell the Difference

Each year, over 800,000 Americans have heart attacks. Far more—upwards of 37 million—experience panic attacks. Telling the difference between the two is not always easy.

“Unfortunately, there is great crossover between the symptoms of a panic attack and a heart attack, making it very challenging to discern between the two without a medical evaluation and testing, such as an EKG,” said Sam Torbati, MD, chair of the Department of Emergency Medicine at Cedars-Sinai and the Levin/Gordon Chair in Emergency Medicine in honor of Joel M. Geiderman, MD.

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Common Symptoms of Heart Attacks and Panic Attacks

According to Torbati, common symptoms of both panic attacks and heart attacks include: 

• Chest or arm pain
• Chest tightness
• Shortness of breath
• Dizziness or lightheadedness
• Sweating
• Passing out
• Chest-tingling or arm-tingling sensations
• Sense of impending doom

Key Differences Between a Heart Attack and a Panic Attack

Although heart attacks and panic attacks have similar symptoms, there can be some differences in how they manifest.

Heart attacks can be sudden and intense, but typically heart attack pain:

• Starts slowly and progresses to tightness, squeezing and heaviness
• Radiates to the left arm, jaw and neck
• Gets worse with exertion

In general, panic attacks:

• Come on quickly, reaching peak intensity in approximately 10-20 minutes
• May be caused by a triggering event (a traumatic experience or major life stress) but also can happen for no evident reason 

Assessing the Risks: Who Is More Likely to Have a Panic Attack or Heart Attack?

Given the similarities between heart attacks and panic attacks, Torbati said telling them apart requires keeping a number of key risk factors in mind.

“The best predictors as to whether symptoms are due to panic attack versus heart attack are the patient’s age and previous history of panic attacks,” he said.

Patients younger than 40 years old, especially those who are healthy and have had previous panic attacks, are more likely to be experiencing a panic attack than older patients and those without a prior history of panic attacks.

Middle-aged people, older adults and people with preexisting coronary artery disease or risk factors associated with coronary artery disease are more likely to be experiencing a heart attack.

The best predictors as to whether symptoms are due to panic attack versus heart attack are the patient’s age and previous history of panic attacks.

Other risk factors that make it more likely a person is experiencing a heart attack include:

• Hypertension (high blood pressure)
• Diabetes
• Obesity
• High cholesterol
• A history of smoking
• Family history of coronary artery disease

“If people with these risk factors are having symptoms of something that could be either heart attack or panic, they should be evaluated by a medical professional immediately,” Torbati said.

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Evaluating the Emergency: What to Do If You Think You’re Having a Panic Attack

Patients who have had panic attacks in the past may be able to manage the onset of symptoms with breathing, relaxation, meditation or other cognitive techniques. They may also take medications provided to them by their doctor for home use.

Young, healthy patients may consider being evaluated in urgent care if they’re having a panic attack for the first time or experiencing prolonged panic attack symptoms.

For older patients who have cardiovascular disease risk factors or known heart disease, as well as for those experiencing new panic attack symptoms, Torbati recommends seeking emergency treatment as quickly as possible.

Patients should immediately go to the emergency room (ER) if they have:

• New chest pain, including tightness, squeezing or heaviness in the chest
• Shortness of breath
• Sweating
• Lightheadedness
• Pain that radiates to the jaw or arm
• A ripping sensation in their chest or back

“We have amazing techniques to treat heart attacks at Cedars-Sinai, but they are most effective if patients come in right away,” Torbati said.

Don’t Doubt or Delay: What to Do If You’re Not Sure

A panic attack can feel urgent and all-consuming, but time is truly of the essence in mitigating the impact of a heart attack.

“The saying ‘Time is muscle’ refers to the importance of treating heart attacks immediately to reduce damage to the muscle of the heart,” Torbati said. “Delays in diagnosis and treating heart attacks can cause permanent heart damage, physical disability or death.”

As a result, Torbati says it is never a bad choice to seek emergency medical assistance in the face of symptoms that could point to either a heart attack or a panic attack. There also are emergent cardiac conditions other than heart attacks that are important to diagnose and treat right away.

“We’re much happier to see a patient with chest pain who turns out not to have a serious medical issue than one who comes in hours or days later when the opportunity to treat them has passed,” he said.