Is it a panic attack or a heart attack?

A sudden racing heart, shortness of breath, nausea and shaking. These symptoms can feel scary if they come on suddenly. And because they share similar symptoms, it can be difficult to tell the difference between a heart attack and a panic attack.

If you experience these symptoms, you might wonder what is happening and whether you should seek medical attention. Brian Miller, MD, a psychiatrist affiliated with Sharp Grossmont Hospital and Sharp Mesa Vista Hospital, and Marin Nishimura, MD, a cardiovascular disease specialist affiliated with Sharp Grossmont, explain the causes and symptoms of panic attacks and heart attacks, as well as what to do if you think you are experiencing either one.

What is a panic attack?
According to Dr. Miller, a panic attack, sometimes called an anxiety attack, can usually be identified by a few symptoms. The main symptom is a sudden feeling of intense anxiety or doom. “Some people describe it as a feeling that something just isn’t right, but they can’t name it,” he says.

Panic attacks can also come with physical symptoms, including:

• Heart palpitations

• A racing heart

• Shakiness

• Shortness of breath

• Feeling disoriented

• Abdominal discomfort

While they are not life-threatening, panic attacks can be frightening. These episodes usually occur “out of the blue” and can happen at any time. Additionally, a panic attack can cause someone fear of experiencing another attack, therefore creating a cycle of anxiety.

Who is at risk for a panic attack?
Panic disorder, or recurring panic attacks, affects 6 million people in the United States. Women are twice as likely to experience them than men.

Risk factors for panic attacks usually involve stress caused by a traumatic life event, death of a loved one or other major life changes. A family history of panic attacks can also be a factor.

Can I prevent a panic attack?
“Education is the best remedy for a panic attack,” says Dr. Miller. “The fear of unexplained anxiety is usually worse than the actual panic attack itself.”

If someone can learn what a panic attack is and recognize it quickly, Dr. Miller says, they can stop it from becoming worse. He recommends talking with your doctor about working together on a treatment plan.

What is a heart attack?
Dr. Nishimura says that a heart attack occurs when the blood flow to your heart muscle is reduced or blocked off. This blockage is typically from a blood clot, or a gel-like clump of blood, that forms in your arteries.

The typical symptoms of a heart attack include:

• Chest pain and pressure

• Shortness of breath

• Nausea

• Cold sweats

• Shoulder discomfort

• Pain in the upper abdomen

“What’s challenging about the management of a heart attack is that the symptoms can vary significantly between patients,” says Dr. Nishimura. “I have seen many cases of heart attacks where the patient didn’t have any chest pain.”

According to Dr. Nishimura, women are particularly at risk for having a heart attack with atypical symptoms. “This can make getting a diagnosis challenging,” she says.

Who is at risk of having a heart attack?
Some groups of people, especially racial or ethnic minorities, experience heart disease at higher rates than others. Additionally, people who have high blood pressure, high cholesterol, diabetes or heart disease are at higher risk for heart attacks.

“Risk factors that increase your chance of heart disease also include smoking, obesity, a sedentary lifestyle and an unhealthy diet,” says Dr. Nishimura.

Age is also a risk factor, she says, as heart attacks are less likely to occur in young people. Finally, having a family member who had a heart attack, especially at a younger age — under age 55 in men and under 65 in women — also increases your risk of having a heart attack.

Can I prevent a heart attack?
“If you have any of the risk factors for a heart attack, the best thing you can do is take control of them to reduce your risk,” says Dr. Nishimura.

While you cannot control certain risk factors, such as your age and family history, Dr. Nishimura suggests opting for a healthier diet, a more active lifestyle and quitting smoking. Talk with your doctor about creating a plan to stop smoking.

How can I know whether I’m having a panic attack or heart attack?
Due to their similar symptoms, distinguishing between a heart attack and a panic attack might feel difficult in the moment. Dr. Miller suggests that if you have risk factors for a heart attack, such as diabetes or a history of high blood pressure, it’s better to be cautious and seek treatment.

If your symptoms are severe, it is important to seek urgent medical attention. “Even for mild or brief symptoms, if you have any questions, you should contact your health care provider for further guidance,” says Dr. Nishimura.

Dr. Nishimura notes that even doctors can’t diagnose heart attacks without further tests, such as blood work and an electrocardiogram (EKG). If you think you or someone you know is having a heart attack, immediately call 911 and seek urgent medical attention.

“When it comes to a heart attack, every second counts!” she says.

Learn more about mental health and heart health.