Is It a Heart Attack or a Panic Attack?

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You suddenly feel chest pain, shortness of breath, and a tingling sensation running through your body.

Is it a heart attack? Or a panic attack?

The two can feel very similar.

To help us differentiate between a heart attack and a panic attack—and know how best to handle both—we talked to Dr. Sam Torbati, co-chair and medical director of the Ruth and Harry Roman Emergency Department.

Dr. Torbati: Unfortunately, there is great crossover between the symptoms of panic attack and heart attack, making it very challenging to discern between the two without a physician assessment and testing, such as an EKG.

Common symptoms that may affect patients with either a panic or heart attack include chest pain, shortness of breath, dizziness, sweating, passing out, tingling, or a sensation of impending doom.

These shared symptoms of heart and panic attack may also be caused by other serious conditions such as blood clots, lung infection or collapse, or tear in the large vessels of the chest for patients with certain pre-existing risk factors. So when in doubt, seek immediate medical attention.

Dr. Torbati: The best predictor as to whether symptoms are due to panic versus heart attack is the patient’s age and previous history of panic attacks.

Younger 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.

Dr. Torbati: Patients with prior panic attacks can start with breathing, relaxation, or other cognitive techniques to abort the panic attack, or they can use medications provided to them by their physician for home use.

Young, healthy patients can be evaluated in urgent care for new-onset or prolonged symptoms of panic attacks.

Middle-aged or older patients or those who have risk factors or known heart disease should come to the ER if their symptoms do not go away quickly—or if their symptoms are different from what they have experienced with other panic attacks.

Patients with recurrent panic attacks benefit greatly from seeing a therapist or psychologist who can help them with panic attacks and other anxiety disorders.

Dr. Torbati: Patients should immediately go to the ER if they have new onset chest pain (tightness, squeezing, heaviness), shortness of breath, sweating, lightheadedness, pain that radiates to the jaw or arm, or a ripping sensation in their chest or back.

Heart attacks tend to occur in middle-aged people and older age groups, so the older the person is, the lower a threshold they should have for coming to the ER right away.

Patients with pre-existing coronary artery disease and those with risk factors associated with coronary artery disease should also be evaluated immediately, including those with hypertension, diabetes, obesity, high cholesterol, or a history of smoking.

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

The saying "time is muscle" refers to the importance of treating heart attacks immediately to reduce damage to the muscle of the heart. Delays in diagnosis and treating heart attacks can cause permanent heart damage, physical disability, or death.

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.