A sharp pain in the chest. Shortness of breath. Tingling in the arms or hands. Nausea, sweating, shaking and a racing heartbeat. Is it a heart attack? It might well be. But it could also be a panic attack. The two conditions have some similarities, and it can be tricky to tell them apart sometimes.
What Is a Heart Attack?
Dr. Tamara B. Horwich, associate clinical professor of medicine, cardiology/cardiovascular disease at the David Geffen School of Medicine at UCLA, says “a typical heart attack occurs when one of the coronary arteries, which are arteries that supply blood to the heart muscle, becomes blocked or obstructed. This leads to a decrease in blood supply to the heart muscle.” A heart attack is also sometimes referred to as a myocardial infarction.
Typical signs and symptoms of a heart attack include:
- Chest discomfort that may feel like pressure, squeezing or pain.
- Pain in the upper body, particularly in one or both arms, the neck, back, jaw or stomach.
- A feeling of fullness in the chest.
- A feeling of severe indigestion.
- Shortness of breath.
- Palpitations or a pounding heart.
- Nausea or cold sweats.
- Flu-like symptoms.
- Paleness in the face or looking unwell.
- A sense of doom.
Dr. Tamer I. Sallam, assistant professor of medicine at the David Geffen School of Medicine at UCLA, says that while pain in the chest or arm is a common sign of a heart attack, it’s not always present, and women in particular “are less likely to experience chest pain and may present with other signs like unusual fatigue or upper body discomfort.”
Heart attacks occur in both men and women, and tend to occur later in life than panic attacks. “The average age of heart attack onset is 65 in men and 72 in women,” Horwich says. “However, heart attacks can occur much earlier in life – in one’s 30s – for people who have very high cholesterol.” Symptoms of a heart attack typically last 30 minutes or longer. Other risk factors for heart attack include:
- High blood pressure.
- High cholesterol.
- Lack of physical activity.
- Chronic stress.
Some individuals are also at higher risk, including:
- People with diabetes.
- Post-menopausal women.
- People with high-stress jobs.
- People who have atrial fibrillation, a heart condition that causes palpitations.
- People with a family history of heart disease or heart attacks.
Heart attacks are typically addressed with a combination of lifestyle interventions (changing diet, increasing exercise) and medications (drugs to lower blood pressure and cholesterol). Some people will also need to have surgery to open up blocked arteries.
Some heart attacks can be instantly fatal, while others are much smaller events that may serve as warning signs to make some changes, such as lowering cholesterol and blood pressure levels, improving your diet and increasing exercise.
What Is a Panic Attack?
“A panic attack occurs when a person experiences a rapid surge of intense fear or discomfort that reaches a peak within minutes,” Horwich says. They may be triggered by a stressful event, such as just before a big presentation or after getting fired. But in some people, there’s no obvious reason for the panic attack to develop. Other symptoms may include:
- Chest pain.
- Pounding heart.
- Fear of dying.
- Fear of “going crazy” and losing control.
- Paresthesia (a feeling numbness or tingling).
Horwich says women are more likely than men to experience them. “Panic attacks are most likely to occur between the ages of 18 and 25.” They can be a one-off or seldom occurrence for some people, while for others, they happen regularly. “Persons with panic disorder experience multiple panic attacks and live in fear of having another one,” she says.
If you’re having a panic attack and recognize it as such, there are some things you can do to shorten its duration or stop it all together. Horwich recommends:
- Deep breathing.
- Light exercise.
- Talking with friends and family.
- Meditation with a mantra.
These activities help take your mind off the panic and help you calm down.
If you’re diagnosed with a panic disorder, you may be prescribed anti-depressants and other medications to prevent additional attacks or reduce their intensity. In addition, some lifestyle changes may also help you gain control of anxiety or a panic disorder. These include:
- Getting plenty of rest.
- Eating right.
- Exercising regularly.
- Managing stress.
- Talking with someone about fears and anxieties.
- Practicing mindfulness, yoga or mediation.
- Making time for yourself.
- Avoiding triggering situations.
Most panic attacks last about 20 to 30 minutes, but there can be some variation to this. And some people may experience panic attacks that last for days.
Where They Overlap
Having a heart attack or panic attack are decidedly unpleasant experiences for anyone. And in some people, having a heart attack could trigger a sense of panic. “It’s not a usual occurrence for a panic attack and heart attack to happen at the same time to a single person,” Horwich says, “but it certainly is a possibility.” While “panic attacks are not a known trigger for heart attacks,” both may have a stress connection. “Chronic stress over time certainly does raise the risk of having a heart attack.”
And because the symptoms can be so similar, it can be difficult to distinguish one from the other in the moment, Horwich adds. “Both panic and heart attacks can be associated with chest pain or chest discomfort, sweating, palpitations and dizziness.”
The best heart attack or panic attack is the one that never happens, so making lifestyle adjustments, particularly if you have risk factors for either condition, can help improve your chances of avoiding either event. Some simple changes may reduce your chances of a heart attack and also reduce the frequency and severity of panic attacks. Try these tips:
- Don’t smoke. The Centers for Disease Control and Prevention reports that smoking is a major cause of cardiovascular disease and causes 1 of every 3 deaths from CVD. Smoking raises levels of fat in the blood and makes blood more likely to clot, which can lead to blockages of blood flow in the heart and heart attacks. It can also damage the cells that line the blood vessels and encourage the buildup of cholesterol and other substances into plaques on the sides of artery walls, thereby narrowing vessels and potentially causing blockages. Similarly, despite their reputation as being “relaxing,” cigarettes are actually bad for people with panic disorder. One long-term study found that panic attacks are more common among smokers, and thus, quitting smoking is recommended as a means of reducing the severity of panic disorder.
- Stay active. We know that exercise is important for many aspects of health, but particularly for cardiovascular health, it’s a key component of any prevention strategy. It can also help you manage feelings of panic, anxiety and panic disorders by helping release endorphins and other feel-good neurotransmitters that calm you and keep you more focused.
- Eat right. A healthy diet will support your body and mind nutritionally and is an important means of keeping your heart healthy. When eating for heart health, look to limit excess sugar, fat and salt. U.S. News’ 2020 Best Heart-Healthy Diets ranking lists the Ornish Diet as its top pick. This low-fat diet that also limits refined carbohydrates and animal protein is more of a lifestyle – it encourages exercise, stress management and healthy relationships. All of these things can support improved heart health and may make panic attacks less likely to occur.
- Know your numbers. Track your blood pressure and your blood cholesterol levels. Atherosclerosis (hardening of the arteries that’s a cause of heart attacks) and hypertension have few symptoms of their own, but high cholesterol and blood pressure can damage the vascular system and lead to blockages.
- Talk to your doctor. If you’re concerned about your heart health or have some risk factors, you should definitely talk with your doctor about ways to reduce your risk of a heart attack. Similarly, if you’ve ever experienced a panic attack, be sure to talk with your doctor about whether you would benefit from taking medications that may decrease your future risk of these events.
- Manage stress. Most of us have a lot of stress in our lives, and managing this through practices such a yoga and mediation may lower your risk of having a panic attack or heart attack.
It’s important to seek help if you or a loved one may be having a heart attack. “If you think you are having a heart attack or if you are unsure if your symptoms are indicative of a panic attack or heart attack, it’s imperative that you seek medical help ASAP,” Horwich says. Seeking appropriate treatment as quickly as possible can literally save your life in the event of a heart attack. “Diagnosing and treating a heart attack as soon as possible can protect your heart from irreparable damage and lead to a longer and higher quality of life.” If in doubt, get checked out.