science of us

How to Tell the Difference Between a Panic Attack and a Heart Attack

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Something I’ve Googled more times than I care to admit (and in more variations than I can count) is “am I having a heart attack,” followed by a list of the symptoms I’m having in that moment. Most often it’s some form of chest pain, but it’s also been heart palpitations, sweaty palms, tingly arms, and shortness of breath. My first recommendation is that you not Google symptoms when you’re mid-possible-panic attack. It’s a minefield of alarmist self-diagnosis out there on the internet, and personally, I’ve never gotten it right once. Not one of these searches has ever made me feel better, and usually they make me feel worse.

Panic attacks can feel pretty different person to person (as can heart attacks), but there are a few good, general principles you can use to help you distinguish between the two the next time you’re an otherwise healthy, youngish person with a weird, panic-inducing chest twinge.

What does a panic attack feel like?

Panic attacks feel awful, which is why they’re scary, and why they’re easy to confuse for a more serious physical health problem. “Often people have a feeling that they might die,” says MaryAnn McLaughlin, a cardiologist at Mount Sinai. Not pleasant! Panic-attack symptoms can also include abrupt, sharp chest pains, tingling in the hands, sweating, shortness of breath, a racing heart, and a sense of doom. But one of the main ways they’re distinguished from heart attacks is by their length — most panic attacks will be over within ten minutes (and often less), while heart attacks can last much longer.

What does a heart attack feel like?

Though chest pain is synonymous with most people’s understanding of what a heart attack feels like, McLaughlin says that’s not totally accurate. “I’ve been a cardiologist for 20 years, and anytime I go to the emergency room and ask patients, ‘Where is your pain,’ the patients having heart attacks constantly say, ‘No, it’s not pain; it’s pressure,’” she says. “There are certain heart attacks that feel like very strong pain. But in general, they start out as a pressure and sometimes a squeezing sensation that can go down either arm.” McLaughlin compares that pressure feeling to a too tight bra — a constriction, or a feeling as though one’s chest is being pressed.

Sweating is also typical of a heart attack, as is nausea — especially for women, says McLaughlin. But crucially, heart attacks, unlike panic attacks, will last longer than ten minutes. Furthermore, absent the typical risk factors for heart attacks — for women, being 60 or older, smoking, high blood pressure, high cholesterol, diabetes — otherwise healthy people in their 20s and 30s especially should try not to worry that they’re having a heart attack because of chest pain, says McLaughlin. Which is, of course, easier said than done, so here are a few more tactics you can use to reassure yourself.

How can I be (pretty) sure I’m not having a heart attack?

Well, first of all, if you don’t have a history of panic attacks, and you do have some of the risk factors for heart attack, and you’re worried about it — go see a doctor, says McLaughlin, because they’re the only ones who can tell you for certain.

But in general, a heart attack is much more likely to accompany exertion, says McLaughlin, whereas a panic attack can occur when you’re sitting and even seemingly relaxed. “A heart attack is less likely to happen out of the blue than to happen to someone who’s shoveling snow, or running up a flight of stars, for example,” she says. Exertion, especially in someone not used to exercise, can increase blood pressure, which McLaughlin says can push people with an impending heart attack over the edge.

So without that kind of recent or current exertion, says McLaughlin, an out-of-the-blue pain in the chest, lasting less than ten minutes, is really less likely to be a heart attack. But even ten minutes can feel like ages, so here are some things you can do when you’re hit with sudden chest pain or fluttering.

How can I slow a racing heart?

One helpful rule of thumb comes from a very patient hotline nurse who once talked me through a panic attack of my own. What she told me, and what I now pass on to you (and which McLaughlin agrees with), is this: You can’t deep-breathe your way out of a heart attack, but you can deep-breathe your way through a panic attack. If you feel your heart racing, breathe in through your nose and out through your mouth several times in a row. If it helps, you’re probably just panicking. If it’s a heart attack, that deep-breathing is going to hurt.

Another technique you can try is the Valsalva maneuver, which basically means bearing down. “The way to describe it is that you’re bearing down, so you put your hand on your abdomen and push your abdomen muscles against your hands,” says McLaughlin. She also compares it to the sensation of having a bowel movement (sorry) or a baby. This maneuver causes rapid shifts in heart rate and blood pressure, which can help restore your normal heart rate.

Thirdly, says McLaughlin, you can drink cold water and/or splash cold water on your face. “There’s something called the diving reflex — there are some sensors inside your nose that slow the heart rate so you can hold your breath and swim longer,” says McLaughlin. “By splashing cold water on your face, or drinking cold water, that can stimulate the vagus nerves to slow the heart rate down.”

If you’re having a panic attack, these tools should help slow your heart rate and breathing. If your heart rate still doesn’t drop, you might want to see your doctor because it’s also possible that you’re having an arrhythmia, or an irregular heartbeat. Often these are harmless, but should be evaluated by a doctor.

Does a 170 heart rate mean I’m having a heart attack? What about 200?

If you’re experiencing a racing sensation in your chest (even after trying deep-breathing or other techniques), take your heart rate. (Place your index and middle finger on your neck, to the side of your throat, and count the number of beats in 15 seconds. Then multiply that by four.) “In general, some fast arrhythmias will go at a rate of 150 and above, and those would definitely lead to feeling faint,” says McLaughlin. “But if a heart rate, in general, is less than 150 beats a minute, in a younger person who’s in their 20s or 30s, it could just be a panic attack.” Even with a heart rate of 180 or 200, McLaughlin says it’s much more likely that you’re experiencing an arrhythmia than a heart attack. If your heart rate is that high, McLaughlin suggests employing the panic-attack techniques above, and seeing your doctor.

Can a panic attack lead to a heart attack?

No. It’s easy to fear that a racing, fluttering chest sensation could be doing real damage to your heart, but McLaughlin says that’s not the case. “An important thing to tell yourself if you’re having a panic attack is that it is not going to cause a heart attack. Even if the heart rate is going fast, it does not lead to a heart attack,” says McLaughlin. “It’s like you’re running a marathon, but your heart is a presumably strong, [young] heart.” There has been some research that suggests that heart disease may occur more frequently in people with a long-term history of generalized anxiety disorder, but McLaughlin warns that the link is far from straightforward. “It’s an association, not a causation, necessarily,” she explains.

Though it can feel like it, a panic attack won’t kill you, and reminding yourself of that when you’re in the midst of one can make it end sooner.

The Difference Between a Panic Attack and a Heart Attack