What Is the Difference Between a Heart Attack and a Panic Attack?

Medically reviewed by Richard N. Fogoros, MD

Your heart starts to pound, and you have pain in your chest. You're short of breath, a little dizzy, and maybe even sick to your stomach. All of these symptoms are common in both heart attacks and panic attacks. A medical evaluation is the only way to know what you're experiencing—even though they are vastly different conditions.

A heart attack (myocardial infarction) occurs when blood flow to your heart muscle is blocked. If the blood flow is not restored, your heart begins to die. A panic attack is a fear response that causes an intense physiological response. The response can feel debilitating, but here's no physiological cause.

Both conditions can cause similar symptoms, making it difficult to distinguish between the two. However, there are some key differences, as well as signs that it's time to reach out to a healthcare provider or seek immediate medical attention.

Symptoms

It's common to assume that chest tightness or discomfort means you're having a heart attack. In fact, chest pain accounts for nearly 5% of all emergency room visits each year.

It can be extremely difficult to distinguish between a heart attack and a panic attack unless you've been diagnosed with panic disorder (a condition characterized by frequent, unexpected panic attacks) and are familiar with the symptoms. Most symptoms mirror one another, including:

• Chest pain

• Shortness of breath

• Nausea

• Lightheadedness

• Heart palpitations

The primary difference is the length of time that you experience symptoms. A panic attack typically comes on quickly and peaks in intensity after about 10 minutes. Heart attacks can also be sudden and intense, but most start slowly with mild pain that gradually gets worse.

Here is an overview of the symptoms of panic attacks and heart attacks:

Differences

A heart attack and a panic attack have strikingly similar and overlapping symptoms, but there are some key differences. For example, they have different triggers and pain qualities.

Triggers for Panic Attack and Heart Attack Are Different

Panic attacks and heart attacks have different triggers. For instance, people who have a panic attack might have a fearful event or thought that triggers a panic reaction. This is related to the "fight or flight" response in the body. Your body responds to stress by releasing hormones like adrenaline (which controls metabolism and blood circulation) and cortisol (which regulates your stress response).

Triggers for a heart attack include:

• Overexertion or sudden exertion (physical activity)

• Air pollution (for example, riding a bike in heavy vehicle traffic)

• Extreme hot and cold temperatures

• Sudden and extreme emotions like anger, anxiety, or fear (which can also trigger a panic attack)

People who have heart attacks also typically have risk factors like hypertension (high blood pressure), high cholesterol, or smoking. About half of all Americans have at least one of these key risk factors for heart disease. The most common cause of a heart attack is coronary artery disease (CAD). Heart attacks can also be caused by a severe spasm (or sudden contraction) of a coronary artery, which supplies blood to your heart.

Panic Attacks Do Not Last Long

Symptoms of a panic attack typically arrive suddenly and end within about 10 to 30 minutes. Panic attacks are usually quick episodes, though they might last longer than 30 minutes.

Heart attack symptoms do not go away. They continue to build and worsen over time. They may come in waves where it feels like the pain might be subsiding or going away before another wave of pain arrives at an intense level. This ebb and flow can lead some people having a heart attack to delay getting help by as much as three hours because they question whether they're having a heart attack or do not want to be embarrassed if it's a false alarm.

Quality of Chest Pain Is Different

Both panic attacks and heart attacks cause chest pain and discomfort, but there is a slight difference in the location and feel of the chest pain. If it's a heart attack, you may also feel pain that radiates into your jaw, neck, back, arm, or shoulders. If it's a panic attack, the pain typically remains in your chest.

People having a heart attack often report feeling a crushing or squeezing pain. They also may report intense chest pressure or feeling like an elephant is sitting on their chest. With a panic attack, people typically indicate that the pain feels like a sharp, stabbing pain that remains in their chest, though it can cause some tingling or numbness in areas like the hands and feet.

Similarities

While there is no denying that the symptoms of both heart attacks and panic attacks are strikingly similar, there are some other commonalities.

Women Tend to Be More at Risk

Heart attacks do not discriminate between men and women, but women tend to have more risk factors that raise their risk of having CAD, the leading cause of heart attacks. These include anemia (reduced number of red blood cells or hemoglobin)—especially during pregnancy—and going through menopause early (before age 40). Other conditions that can raise the risk of CAD include:

• Endometriosis: When tissue that is similar to the lining of the uterus (known as the endometrium) grows outside the uterus

• Gestational diabetes: Higher blood sugar levels during pregnancy

• Preeclampsia: Hypertension during pregnancy

Women are also more prone to have a panic attack or be diagnosed with panic disorder. One study suggests that panic disorder occurs 2.5 times more frequently in women than in men.

Both Conditions Are Common

The Centers for Disease Control and Prevention (CDC) reports that a heart attack occurs every 40 seconds. Each year, about 805,000 people in the United States have a heart attack, with about 605,000 of those representing a first heart attack. What's more, about 20% of deaths are caused by heart disease.

Panic attacks also are common. They affect hundreds of thousands of people in the U.S. each year. Some experts estimate that as many as one in five people will have a panic attack at least once in their lives.

Stress and Anxiety Can Play a Role in Both

Stress and anxiety do not cause a heart attack, but they can lead some people to develop coping mechanisms like drinking, smoking, or eating high-fat and highly processed foods. These habits increase the risk of a heart attack. Chronic stress also can increase blood pressure and has been linked to more cardiovascular events.

Stress and anxiety can also play a role in panic attacks. For instance, a panic attack might be triggered by a stressful life event. Like heart attacks, chronic stress also plays a role in the development of panic disorder.

Related: Symptoms of Heart Attacks in Women

Can You Have Both a Heart Attack and a Panic Attack?

A panic attack does not normally cause a heart attack, but it's possible for a person diagnosed with panic disorder to have a heart attack. It's also possible for a person experiencing a heart attack to have panic symptoms.

Research shows that people with anxiety disorders like panic disorder may have an increased risk of heart disease due to low heart rate variability. Low heart rate variability means that your heart rate doesn't change much in relation to activity level. It might indicate that your body has difficulty adapting to changing situations and recovering.

When To Seek Care and Who to Contact

A heart attack is a medical emergency and requires immediate medical attention. A panic attack is not usually an emergency. That said, because the symptoms overlap and mirror one another, it can be challenging to tell the two apart without a medical evaluation. For this reason, always get immediate medical attention for chest pain, even if you suspect you are having a panic attack.

You might still want to get an evaluation even if you've been diagnosed with panic disorder, especially if you have known risk factors for a heart attack. Some research indicates that being diagnosed with panic disorder increases your risk of a heart attack by 36% and your risk of heart disease by 47%.

Consider scheduling an appointment with a mental health professional or speak with the on-call mental health professional at the hospital if you're diagnosed with having a panic attack after the evaluation. These professionals can help you identify triggers for your panic symptoms and learn coping mechanisms. You also may be prescribed medications to help manage the condition.

If you have a heart attack, you will likely be referred to a cardiologist (a medical doctor who specializes in cardiovascular conditions). They can help you develop a recovery plan as well as suggest lifestyle changes to reduce your risk of future heart attacks. These changes may include new medications, a cardiac rehabilitation program, and lifestyle modifications. Altering your lifestyle and keeping your appointments are an important part of reducing your risk of another heart attack.

A Quick Review

A heart attack and a panic attack share symptoms like chest pain, dizziness, a racing heart, shortness of breath, and nausea. For this reason, it can be challenging to distinguish between the two without a medical evaluation—especially if this is your first time experiencing symptoms.

Both are extremely common conditions that can be triggered by stress and anxiety, and their differences can be difficult to identify. The general rule of thumb is to always be evaluated for chest pain—even if you have panic disorder—to ensure you get the care that you need.

For more Health.com news, make sure to sign up for our newsletter!

Read the original article on Health.com.