Will I be able to tell the difference between the physical symptoms of a panic attack and a heart attack?

April 8, 2010 11:59 AM

ParanoidFilter: For the longest time I've been getting chest pain with my anxiety. Will I be able to tell the difference between the physical symptoms of a panic attack and a heart attack?

I have a history of panic attacks, stress, anxiety and the oh-so-fun chest pain that comes with it. My GP, therapist and prescriber of brain medicine have all stated that this is totally normal.

So, deity forbid, if I do have some sort of bad heart situation, will I be able to tell the difference? Do people say, "oh, it's just another panic attack" and it turns out to be a heart attack?

I'm in my mid-20s, fairly healthy and active, but with heart problems in the family. I will end up asking my doctor, but my appointment is a couple of months away.

posted by anonymous to Health & Fitness (10 answers total)

You don't mention if you are a man or a woman, but one thing to consider is that women's symptoms are often different from men's.
posted by Kimberly at 12:15 PM on April 8, 2010

Do your panic attacks usually follow kind of a pattern? Example - there is some stimulus ... you start feeling on edge ... then anxious ... then your whole body starts to clench ... then the chest pain.

I think if you noticed that your usual anxiety and panic attack pattern had come before the pain, it would be more likely that it was yet another panic attack. However if you were going about your day feeling totally fine, and then the pain came out of the blue, I'd be more worried about that.

Also - are there things you do during panic attacks that help them go away? Deep breathing, going to a space where you feel more comfortable, etc. If those things work as usual, then probably just another panic attack. If not, I think that could be a sign for you that it might be something else.
posted by Ashley801 at 12:23 PM on April 8, 2010

I have this exact same problem and even ended up in the ER a few weeks ago because I freaked out and thought I was having a heart attack. I am not a doctor or claim to possess any knowledge of real heart conditions, but for me, I assume that it's anxiety induced when I find myself distracted and happy and the chest pains go away. YMMV. Mine also went away when I was given an anti-anxiety med in the ER.

My therapist is helping me figure out how to deal with my panic and chest pains and I hope that you will be able to get some help with yours too. I wish I could share more but I'm just starting to learn about all this. I no longer have a copy of an article my therapist gave me, but it described all of the ways that panic can affect a person physically and ever since I read it, I have barely experienced chest pains at all.
posted by bristolcat at 1:15 PM on April 8, 2010

IANAD, however I was a Firefighter/EMT and an instructor in CPR certified by the American Heart Association. I have also had heart surgery. The symptoms of heart attack are varied amongst people not only by gender, by by the type of heart problem they are having. They are, to an extent, similar to the symptoms presented during a panic attack. You are probably aware, that these symptoms can also vary from person to person. While I can't say this with absolute certainty, I believe that, if you have a heart attack, you will notice differences in your own personal symptoms. For example, your panic attack symptoms my include pain that extends broadly across the upper chest, while your heart attack symptoms may include pain that is sharper, extends up into the jaw, across the shoulders to the upper back and extend down your left arm. These scenarios can be different for each individual. What I'm trying to describe is that you might feel a difference between symptoms you are familiar with. Additionally, mild exercise, like getting up and walking across the room, can tend to lesson your panic symptoms, while they would aggravate heart attack symptoms.

The simple response for you is to take a deep breath and try to relax. If this does not help, assume it is a heart attack in order to be on the safe side and call 911 (in the U.S). When the paramedics or EMT's come, they will be better able to assist you in deciding what your status is.
posted by Old Geezer at 2:41 PM on April 8, 2010 [1 favorite]

Assuming your doctor establishes that you don't have a heart problem, it would probably be helpful for you to work with the feelings of anxiety so they're less troublesome to you. In her book When You're Falling, Dive: Acceptance, Freedom, and Possibility, Zen teacher Cheri Huber talks about paying attention to the cycle of how we process our experience:

To understand how acceptance can help us accomplish positive change, says Huber, it’s helpful to examine the way that we typically process our daily life experiences. She breaks the evolution down into five steps:

First there is MOVEMENT: Some-thing happens in our lives, something shifts, slips, advances or evolves. It may be a big event, a tiny incident, someone’s passing comment or a nearly imperceptible change in the environment.

Second, there is SENSATION: We feel or experience something physically – a twinge of pain, a flood of heat or cold, a clenching or emptiness in our body, a vibration or fluctuation we can’t name.

Third, we have A THOUGHT: We consciously or unconsciously identify the sensation and assign some kind of reason or meaning or value to it.

Fourth, we have an EMOTIONAL REACTION to the thought: It may be a flash or wave of a certain feeling or it may be a combination of them – grief, fear, anger, irritation, shame, nervousness, hurt, desire, relief, etc.

Fifth, there is BEHAVIOR: We take some kind of action or reaction, verbally, physically or attitudinally – either to stop the feeling, escape it, or to do something else about it.

This article has more.

I struggle with depression + anxiety and have found the awareness practice Cheri teaches, and especially this particular exercise of paying attention to the movement->sensation->thought->reaction->behavior cycle, to be extremely helpful. Instead of my brain making that split-second jump from What's that sensation behind my sternum? to omigod everything sucks it's all going to hell I can't cope I can't think I can't breathe HELP!!!, I'm able more often to stay with the feeling so the cycle looks more like There's a sensation behind my sternum... okay, breathe and stay with it and really experience the feeling... keep breathing and keep feeling it... keep breathing and — wait, where'd it go? Huh... I feel fine now.

Best wishes. Anxiety attacks are horrible.
posted by Lexica at 4:09 PM on April 8, 2010

Here's what you do: get to a Cardiologist. Get a stress test. If you're in your mid-20s, unless you're morbidly obese, Downs syndrome, some familial hypercholesterolemia disease, you don't have heart disease. However, with your family history + the confusing anxiety symptoms, I'd recommend getting frequent (every year or other year) stress tests. Then when you're 40-45, get a cardiac cath and see. Otherwise, it's phenomenally unlikely that you're going to have a heart attack (or any myocardial ischemia) if you're 25 and healthy.
posted by ruwan at 6:36 PM on April 8, 2010

IANAD, but I was under the impression that the pain of a heart attack occurs primarily in your left shoulder, back, and neck as opposed to your chest. The phenomenon is known as referred pain, and the reason for it is actually really interesting: the nerves carrying pain sensations from the heart hook up to sympathetic (as opposed to somatic) nerve fibers on the way to the spinal cord. Because pain usually comes in on somatic fibers, the brain/spinal cord assume the pain is coming from the somatic nerve fibers terminating in the same part of the spinal cord. The result is that the pain is felt in a different area (your shoulder) from where the trauma is actually occurring (your heart).
posted by dephlogisticated at 7:30 PM on April 8, 2010

Despite meeting none of ruwan's criteria, at 24 I was diagnosed with heart disease. I also have anxiety issues (have had panic attacks since I was 12, and heart disease has a poorly-understood relationship to depression and anxiety). My cardiologist or his nurse practitioner told me that you know it's not a heart attack if it gets better or goes away. Pain from a heart attack will always get worse. Now, I'm not sure how true that is, because my father had intermittent discomfort that ended up being a heart attack (much to the surprise of the ER personnel) but it was comforting to hear. But Old Geezer's advice is excellent, and would indeed have differentiated my panic attacks (better on walking) from my father's stealthy heart attack (pain worst on walking/exertion).
posted by katemonster at 8:15 PM on April 8, 2010

Two stents put in on an emergency basis although they claimed I did not have a "heart attack". I think you would know the difference. I have had anxiety type tightness in my chest and that was nothing like the pain I felt that lead me to the doctor (after about tow weeks of intermittent pain like katemonster's pop) to ask about the pain in my chest. But more importantly, about a year after my procedure, I was having pains in my chest and I called the doctor. I was under a lot of stress. He asked me if it was the same pain as last time. I told him no. He said that everyone has slightly different pains, but it would likely be consistent from event to event if I had another event. Not sure if I really believe him, but it makes me a lot less paranoid when I work out or have some sort of stressful event.
posted by JohnnyGunn at 10:08 PM on April 8, 2010

To dephlogisticated, I wish it were that simple, though what you point out about referred pain is very true.

You have to remember that every person's anatomy is different, and people can have heart attacks (or other heart problems) that cause pain in different parts of their heart. So people can have heart attacks with pain around their epigastric area (over the stomach), under their sternum, left side of the chest, shoulder, arm, jaw, back, even the right side of the chest/right jaw etc.

The bottom line is that no decent doctor assumes that something is "just stress" unless they have done tests to help them make sure it's not something more serious. Now, if you go to the emergency department every week, you may gain that notoriety and get taken less seriously, but you should still get at minimum an EKG (and possibly a chest x-ray, and possibly blood work) every single time you complain of chest pain. This will become expensive quickly unless you can figure out the characteristics of your anxiety related pain and figure out when it's different, as folks are describing above. Despite what katemonster and Old Geezer say, you cannot reliably differentiate heart attacks from other chest pain just by certain qualities of the pain, though some qualities of the pain may be more suspicious than others.

For example, one description of classic heart attack is ongoing, crushing, substernal chest pain that radiates to the left shoulder and arm, accompanied by nausea and sweating and worse with exerting yourself. But that doesn't mean that when someone comes in with sharp, intermittent chest pain that doesn't radiate anywhere and happens when you're resting, it's not a heart attack - unfortunately, otherwise it would make my job much easier! To katemonster, the pain from a heart attack WILL eventually get better - once the heart attack is complete and that part of the heart muscle is dead, it doesn't hurt anymore! Or, if the pain is on and off, it could mean that you have unstable angina, which is bordering on heart attack territory. The safest thing is to make no assumptions, at least in my line of work which is emergency medicine.

As you get older and have more risk factors such as cholesterol, or smoking, people will be more likely to do things like repeat blood work on you over the course of hours to be sure that your chest pain is not a heart attack, because EKGs do not show all heart attacks. You will also get stress tests. So, through more extensive testing, we will be able to deduce what's causing your pain. What ruwan says about getting your primary care doctor to organize a stress test for you every couple of years could be quite helpful. If you have a history of people in your family having heart attacks, and the youngest person in your family to have one was 45, for example, you could get a stress test when you are 35. In the meantime, work hard to control those risk factors by continuing to eat well, exercise, keep your weight down, and avoid smoking. That is a long answer but I hope it is helpful.
posted by treehorn+bunny at 8:23 AM on April 9, 2010