Heart Attack Versus Panic Attack: Identifying the Difference for Your Long-Term Health

Chest tightness. A racing heart. Sweaty palms. That sudden, overwhelming sense that something is very wrong. When these symptoms strike, it’s natural to fear a heart attack—but sometimes, it could be a panic attack. Understanding the differences between a heart attack versus panic attack can be lifesaving.

Because the symptoms often overlap, distinguishing a heart attack from a panic attack can be difficult. Emergency room physicians encounter this challenge daily, evaluating patients with chest pain, rapid heartbeat, and acute anxiety.

Dr. Arash Bereliani frequently treats patients caught in this terrifying middle ground. Even the most health-conscious individuals can find it nearly impossible to tell a heart attack from a panic attack without a professional evaluation.

Learning the underlying mechanisms of both is the first step toward regaining control over your cardiovascular and mental health. Keep reading to learn what you need to know about a heart attack versus a panic attack.

Why Are Heart Attack and Panic Attack Symptoms So Similar?

To understand the overlap, we must look at the human body's "alarm system." When the brain perceives a threat, it activates the sympathetic nervous system. Whether that threat is a physical blockage in an artery or a psychological trigger of intense fear, this is the well-known "fight or flight" response.

During this time, the adrenal glands release hormones such as adrenaline and cortisol into the bloodstream. These chemicals are designed to prepare the body for immediate action.

They increase the heart rate to pump more blood to the muscles and constrict certain blood vessels. In an anxiety episode, this system is misfiring; there is no physical danger, but the heart and lungs respond as if there were. Because the final chemical output—the adrenaline surge—is the same in both scenarios, the resulting sensations feel nearly identical.

What Does a Heart Attack Feel Like Compared to Anxiety?

A heart attack, or myocardial infarction, occurs when blood flow to a part of the heart is severely reduced or blocked, usually by a buildup of plaque or a ruptured clot. Without oxygen-rich blood, the heart muscle begins to suffer damage.

The pain of a heart attack is typically described not as a sharp or stabbing sensation, but as a heavy, crushing pressure. This discomfort often radiates beyond the chest. It is common for the pain to travel up into the jaw or neck, down the left arm, or even into the back between the shoulder blades.

Unlike the sudden "spike" of an anxiety episode, heart attack symptoms often develop more gradually. They may start as mild discomfort that builds over several minutes.

If the pain is provoked by physical exertion, such as walking up a flight of stairs, and eases slightly with rest, the likelihood of a cardiac origin is significantly higher. This distinction is vital when evaluating a heart attack versus a panic attack.

How Can You Recognize the Signs of a Panic Attack?

A panic attack is an intense episode of fear that peaks very quickly, usually within 10 minutes. While it is a psychological event, the physical symptoms result from a massive, sudden discharge of the autonomic nervous system.

While a panic attack can cause chest tightness, the pain is often sharper or more localized than the broad, heavy pressure of a heart attack. One of the hallmark signs of a panic attack is hyperventilation.

When we breathe too quickly and shallowly, the levels of carbon dioxide in our blood drop, which can cause unique sensations that are rarely seen in heart attacks. These include tingling or numbness in the fingertips, around the lips, and in the feet.

One significant metric we look at is the heart rate in a panic attack. During a panic attack, the heart rate can skyrocket almost instantly, often accompanied by palpitations or the feeling that the heart is skipping a beat.

While a heart attack also increases heart rate, it is usually accompanied by a sense of extreme physical exhaustion or "heaviness" that differs from the frantic, high-energy racing of an anxiety-induced pulse.

Can a Panic Attack Cause a Heart Attack?

This is one of the most nuanced questions in cardiology. From an immediate, clinical perspective, a single panic attack in a person with a healthy heart is not a direct cause of a heart attack. A panic attack does not create a physical blockage in your coronary arteries.

However, as a specialist in Functional and Preventive Cardiology, Dr. Bereliani looks at the long-term relationship between the mind and the heart.

The answer lies in chronic stress. Repeated panic attacks mean that the cardiovascular system is being subjected to frequent, intense "adrenaline storms." Over time, this chronic stress can contribute to systemic inflammation and endothelial dysfunction—the delicate lining of your blood vessels can become less flexible and more prone to damage when exposed to chronic high levels of cortisol.

The most critical advice any cardiologist can give is this: never attempt to self-diagnose chest pain while it is happening. Because the symptoms of a heart attack versus a panic attack are so deceptive, the risk of being wrong is too high.

If you experience new, unexplained chest pressure, especially if it is accompanied by nausea, cold sweats, or pain radiating to your jaw or arm, you must call 911 or seek emergency care immediately. It is always better to be evaluated for a heart attack and find out it was a panic attack than to ignore a cardiac event until it is too late.

Once a crisis is ruled out, the journey to true health begins. By addressing both the heart's physical health and the nervous system's functional health, we can help you live a life free from the fear of the "next attack."

Whether it is optimizing your heart health or managing the physiological triggers of anxiety, our goal is to ensure your cardiovascular system is resilient enough to handle whatever life throws your way.

Dr. Arash Bereliani and his team provide the most advanced, integrative cardiovascular care in Los Angeles. Contact us today to schedule a comprehensive preventative evaluation.

Author

Arash Bereliani, M.D., M.S., F.A.C.C. Beverly Hills Institute For Cardiology & Preventive Medicine