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Panic Attack or Heart Attack?

Contributed by Fahmi Farrah, MD
Cardiologist on the medical staff at Baylor Scott & White Heart and Vascular Hospital – Fort Worth

For some people, especially women, heart attacks don’t announce themselves in the usual way, with crushing chest pain that’s incapacitating and unmistakable. Less dramatic symptoms, such as an irregular heartbeat, shortness of breath, nausea, dizziness, indigestion, fatigue, numbness in hands and feet and discomfort that goes away, can also signal a heart attack – and need the same immediate medical attention.

But those symptoms also sound a lot like a panic attack, which is the feeling of impending doom, very similar to the symptoms of an acute heart attack and therein lies the quandary: how do you tell the difference?

While a heart attack is life threatening, a panic attack is not and should be discussed with your doctor. Adding to the anxiety are statistics indicating that women suffering a heart attack may wait longer before seeking help, possibly because of the uncertainty of whether it’s truly a heart attack. This delay in treatment can have deadly consequences and is part of the reason why more women die from heart disease compared to men.

There’s no foolproof way to differentiate between a heart attack and a panic attack. But there are ways to assess which is more likely. Heart attacks occur suddenly that can be triggered by physical or emotional exertion and sometimes without any trigger at all, with symptoms that persist longer and get worse. Age is also a factor and people older than 40 years of age are more likely to have heart problems because they have more risk factors, while the same symptoms in younger people could just be panic attacks. However, heart disease is now more prevalent among the younger generation as well and similar symptoms in them should not be overlooked.

Although some panic attacks occur spontaneously, others are linked to a stressful event or situation and tend to pass within an hour. Panic attacks also may be recurring episodes, caused by the same fears or circumstances, or even the fear of having another panic attack.

The preparation to take better care of your heart starts with knowing the risk factors for heart disease and whether they’re under control. The list may be familiar, but always bears repeating: family history, obesity, high blood pressure, diabetes, smoking, high cholesterol, and, of course, the presence of existing heart problems.

The higher the risk of heart disease, the greater the likelihood of a heart attack. Even without any symptoms, patients and doctors should be monitoring heart health and working to lower the risks through diet, exercise, smoking cessation and guideline directed medical therapy. It is important to know that 85% of all heart disease is preventable. This window of opportunity is available before you become symptomatic. Therefore, it is of utmost importance to be proactive and see a doctor if you have risk factors and not wait for symptoms to occur.

So what do you do if you think you are having a heart attack?

The bottom line is clear: when in doubt, seek the appropriate help and call EMS. Procedures ranging from electrocardiograms and blood tests to cardiac catheterization and MRI can diagnose heart disease and determine whether a heart attack has occurred. If heart disease is ruled out, the focus should then turn to mental health.

Anxiety disorders that lead to panic attacks can be treated with medication and counseling and shouldn’t be ignored, because panic attacks and heart attacks have more in common than just symptoms.

According to the American Heart Association, stress is a risk factor for heart disease and may also worsen some of the other risk factors by raising blood pressure and propagating harmful habits such as drinking, smoking and eating unhealthy. Stress is also linked to takotsubo, which is stress induced cardiomyopathy. This is a form of heart failure that occurs by weakening of the left ventricle and is also known as “broken heart syndrome.” This phenomenon is most commonly seen in women.

There is certainly a link between mental health and heart health, which stresses the importance of taking care of both. Even if those ominous symptoms turn out to not be a heart attack, the next time could be different. We should never let our guards down when it comes to matters of the heart.


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