How To Tell the Difference Between a Heart Attack and a Panic Attack

The symptoms come on quickly: You feel your chest tighten, your heart rate skyrockets and you start sweating.

It’s an alarming scenario, and your mind races to figure out what’s happening. Is it a heart attack? Or is it a panic attack? It can often be difficult to tell the difference (especially if you’ve had neither) and that only adds to the confusion and stress.

Both events are serious and it’s important to recognize which one you’re experiencing so you can get proper treatment.

So, how can you tell the difference when it comes to a panic attack vs. a heart attack? You want to focus on how the pain feels, the location of your pain, when it started and how long it lasts.

Cardiologist Mistyann-Blue Miller, MD, explains what these two conditions have in common and how they’re different.

Can they feel similar?

A heart attack is when part of your heart doesn’t get enough blood. This usually happens because an artery that supplies blood to your heart is blocked.

A panic attack is a sudden attack of overwhelming fear or anxiety, triggered by your body’s fight-or-flight response. Panic attacks aren’t life-threatening, but they interfere with your quality of life and mental well-being.

People who have regular or frequent panic attacks may have a panic disorder, a type of anxiety disorder. But an isolated panic attack can happen to anyone, even without a panic disorder diagnosis.

While it’s easy to confuse both conditions and how they feel, you want to really focus on how your chest pain feels.

A heart attack feels like:

• Chest pressure.
• Feeling of squeezing or, says Dr. Miller, “Like an elephant sitting on your chest.”
• Achy or burning sensation, like heartburn.

A panic attack often causes:

• Sharp or stabbing pain (not typical with a heart attack).
• Heart racing or chest discomfort that is hard to describe.

How to tell the difference between a heart attack and a panic attack

First, let’s talk about the symptoms associated with both conditions.

Common heart attack symptoms include:

• Chest pain or pressure.
• Pounding or racing heart.
• Feeling lightheaded or faint.
• Sweating, including cold sweats.
• Pain or discomfort in your upper body, such as your jaw, neck, arms, shoulders or back.
• Shortness of breath.
• Nausea or vomiting.
• Feeling of impending doom.

Remember, a heart attack can be life-threatening, so don’t wait to see if the symptoms go away. Seek immediate medical care if you have signs of a heart attack.

Symptoms of a panic attack include:

• Chest pain.
• Pounding or racing heart.
• Sweating.
• Trouble breathing.
• Stomach pain or nausea.
• Feeling of impending doom.
• Sudden feelings of strong anxiety and fear.
• Shaking or trembling.
• Weakness or dizziness.

In many cases, a panic attack triggers a fast heart rate, also known as tachycardia. The heart rate may speed up to 200 beats per minute or even faster.

A fast heart rate can make you feel lightheaded and short of breath. Or you might feel fluttering or pounding in your chest. Usually, tachycardia that happens in response to emotional stress and only lasts a few minutes isn’t harmful. But if it happens regularly, or you have possible symptoms of a heart attack, seek medical care.

So, while some symptoms of a heart attack vs. a panic attack overlap, like chest pain, shortness of breath, nausea and feelings of impending doom, Dr. Miller explains the key distinctions to watch for.

The location of pain

While both heart and panic attacks cause chest discomfort, you want to zero in on where the pain is.

“With a heart attack, pain radiates to other areas like the arm, jaw or neck,” says Dr. Miller. “If it’s a panic attack, pain will typically stay in the chest.”

When you experience pain

Another key difference between a heart attack and a panic attack? Heart attacks tend to happen after physical strain or exertion — a sign not found in panic attacks.

“A heart attack might happen after shoveling snow or walking up a long flight of stairs,” clarifies Dr. Miller. “But you wouldn’t have a panic attack after exercise unless there was an emotional stress trigger with it.”

But what if the symptoms hit you at night? Both panic attacks and heart attacks can wake you from sleep. But there’s a key difference: People who have nighttime, or nocturnal, panic attacks usually have daytime panic attacks, too.

So, if you wake up with chest pain or other symptoms, and you don’t have a history of panic attacks, that might be a sign of a heart attack.

How long the pain lasts

Panic attack symptoms last a few minutes or up to an hour. Then, the symptoms disappear, and you feel better. But a heart attack won’t let up.

Pain and symptoms of a heart attack might keep going or come in waves where it gets better and worse.

“Heart attacks can cause severe chest pain, like a 9 or 10 on the pain scale,” states Dr. Miller. “Then later, the pain may drop to a 3 or 4 before it gets worse again. The pain might change, but it won’t go away.”

What to do if you’re unsure

One thing of note? Emotional stress plays a role in both conditions.

“Both panic attacks and heart attacks can occur during or after a stressful situation,” says Dr. Miller. “But most of the time, people have a panic attack rather than a heart attack in response to emotional stress.”

People who have anxiety, depression or chronic stress may have a higher risk of heart problems. Chronic stress can lead to high blood pressure, which raises the risk of heart attack and stroke.

It’s also important to know that a heart attack might seem like it came out of nowhere. But in many cases, chest pain due to heart disease, known as angina, appears in the days or weeks before a cardiac event.

“You may feel a twinge or some pain in the shoulder or chest but think it’s something else,” notes Dr. Miller. “The symptoms go away. Then later, the pain gets worse, or you feel a little off. Then, the heart attack hits. These early signs can be hard to identify.”

A heart attack is a medical emergency. A panic attack isn’t. But with the overlap in symptoms, it can be tough to tell them apart. Don’t take chances. If you have chest pain or other heart attack symptoms — or if you’re not sure if it’s a heart attack or panic attack — seek immediate medical care.