Is it a heart attack – or a panic attack?

13 Aug

by Carolyn Thomas  ♥  @HeartSisters

As a heart attack survivor who was misdiagnosed and sent home from the E.R., I now have a keen (maybe obsessive?) interest in women whose cardiac events are being dismissed by doctors. Reports in the New England Journal of Medicine, for example, show that women under age 55 are SEVEN TIMES more likely than men to be misdiagnosed in mid-heart attack and sent home.(1)

But sometimes, people who are utterly convinced that they’re suffering from misdiagnosed heart problems may instead have conditions like panic disorder. In fact, Dr. Mohammed Memon, editor-in-chief at Medscape Reference, cites studies showing that about 40% of patients with panic disorder seek treatment because of frightening chest pain. But how to tell the difference? 

Here’s what Dr. Memonhas to say about panic disorder:

“Panic disorder is characterized by the spontaneous and unexpected occurrence of panic attacks, the frequency of which can vary from several attacks per day to only a few attacks per year. Panic attacks are associated with more than one month of subsequent persistent worry about:

  • 1. having another attack
  • 2. consequences of the attack, or
  • 3. significant behavioural changes related to the attack”

Mental health professionals tell us that panic attacks are a period of intense fear in which defined symptoms develop abruptly and peak rapidly, usually less than 10 minutes from symptom onset.

And these terrifying symptoms may indeed mimic those experienced during a heart attack.

Mayo Clinic experts include anxiety or panic attack chest pain in their descriptions of all-cause chest pain.  For example:

“Anxiety or panic attacks are characterized by surges of intense anxiety and fear that occur without warning and with no apparent reason. Panic attacks may be accompanied by sharp and abrupt chest pain, most likely caused by muscle contractions in the chest wall. The chest wall may feel sore for hours or days after a panic attack. Though easily treated with medication and relaxation techniques, anxiety and panic attacks can significantly disrupt an individual’s life.

Other panic symptoms can include:

  • Palpitations, pounding heart or accelerated heart rate
  • Sweating
  • Trembling or shaking
  • Sense of shortness of breath or smothering
  • Chest pain or discomfort
  • Nausea or abdominal distress
  • Feeling dizzy, unsteady, light-headed or faint
  • Fear of dying
  • Numbness or tingling sensations
  • Fatigue

Some of these possible symptoms can also be experienced by women during a cardiac event.

But here’s how Dr. Thomas Edwards, who is the Clinic Director at Anxiety Network International, reassures those alarmed by the pounding heartbeat symptoms of panic disorder:

“When people having a panic attack say: ‘I can hear my heart beating even in my ears!’, they are not likely experiencing heart problems. Those who are having a real heart attack do not hear their heart beating, nor do they care.”

Here are some basic but important differences(2) between the two conditions:

HEART ATTACK

  • Escalating chest pain (starts small and gradually increases over time)
  • Pain, pressure, heaviness, fullness or aching (may come and go away)
  • Pain in the substernal or left chest area
  • Pain or discomfort that travels or radiates from the chest to other areas, such as one or both arms, abdomen, back, shoulders, neck, throat or jaw
  • Discomfort that is brought on by exertion (although unstable angina may bring about pain without exertion)
  • In 8-10% of women’s heart attacks, there are NO chest pain symptoms at all (3)

PANIC ATTACK

  • Sharp or stabbing chest pain
  • Chest pain that is fleeting
  • Pain that is localized to one small area
  • Pain that usually occurs at rest
  • Pain that accompanies anxiety
  • Pain that is relieved or worsened when you change positions
  • Pain that can be reproduced or worsened by pressing over the area of pain
NOTE FROM CAROLYN:     I am not a physician so cannot offer a medical opinion of your symptoms. Please do NOT leave a comment here describing your chest pain or other troubling symptoms. See your physician for professional help.
(1)  Pope JH, Aufderheide TP, Ruthazer R, et al. Missed diagnoses of acute cardiac ischemia in the emergency department. N Engl J Med. 2000;342:1163-1170.
(2)  Katerndahl MD MA, David. “Panic & Plaques: Panic disorder & coronary artery disease in patients with chest pain.” The Journal of the American Board of Family Practice 2004 17:114-126.
(3) S. Dey et al, “GRACE: Acute coronary syndromes: Sex-related differences in the presentation, treatment and outcomes among patients with acute coronary syndromes: the Global Registry of Acute Coronary Events”, Heart  2009;95:1 2026.

See also:

 

22 Responses to “Is it a heart attack – or a panic attack?”

  1. lila October 28, 2014 at 7:23 pm #

    Im 29 i often have heart palpitations ..sometimes i can feel my heart beating fast and then it’ll skip 2 or 3 beats and go back to normal. Right now im experiencing my heart is racing pounding outta my chest im just laying down going to bed and all of a sudden it started ..its also accompanied with pain in my chest bone almost like an ache feeling it started at 9:49 and it is now 10:22 and my heart is still racing. im trying to keep calm…praying that this feeling leaves

    Like

    • Carolyn Thomas October 28, 2014 at 7:45 pm #

      Lila, make an appointment with your doctor and explain these symptoms to him/her. Meanwhile, just keep a journal of symptoms (time, severity, description, what you were doing in the 2-3 hours before they began) so you’ll have a record to show. And meanwhile, try to breathe nice and deeply to remain calm – as fretting will only worsen how you feel.

      Like

  2. Ricardo October 27, 2014 at 7:10 pm #

    I Have most likely all those symptoms, what should I do? I’m only 16. My chest feels really hard/tight and I have real trouble breathing and have shortened breath. I felt like I was going to pass out in class today, my heart was beating hard and really fast. All I thought in my head was, I’m going to have a heart attack and I’m going to die. Please if anyone can help it would be great, god bless!

    Like

    • Carolyn Thomas October 27, 2014 at 9:15 pm #

      Ricardo, please go see your doctor. Your experience in class was frightening, but the fact that you were able to write this comment later on shows that you did not have a heart attack or die. It would be unusual for a person your age to be having a heart attack. Something is causing your symptoms – they very well could be caused by anxiety, which can be treated. Do not hesitate to get help in finding out what that is. Meanwhile, read this post on how to handle anxiety for some helpful tips that might help – several of which you can try on your own.

      Like

  3. Bhaktara meher October 19, 2014 at 5:37 am #

    I have pain in different area in left chest pounding of heart rate anxiaty fear of dying. can any problem to heart

    Like

  4. Stacey September 2, 2014 at 7:17 pm #

    I am 33 yrs old and been having a lot of chest pains along with numbness in arms and face and staying really tired a lot and the pain and symptoms keep getting more unbearable. On heart meds already to lower my heart rate.

    Like

  5. Lisa Byrne November 10, 2013 at 3:07 pm #

    Hi
    Thanks for a great post – so glad I stumbled across your blog, i often feel like that. I know it’s just thoughts and fears inside me. I try to stay rooted in the present moment but sometimes that just doesn’t happen for me.
    Thanks again.
    Lisa x

    Like

    • Carolyn Thomas November 10, 2013 at 4:28 pm #

      Hello Lisa – thanks so much for sharing that interesting video. Very helpful!

      Like

  6. Grandioz August 23, 2011 at 2:46 am #

    It is an irony indeed. We should check with doctors when we are not sure about our condition, only to be dismissed with “it is just your imagination”. While it is not easy to diagnose the symptoms because of the similarity, but with that many misdiagnosed rate, I think the doctors are not being alert enough. It is time that we ourselves need to educate ourselves even a little.

    Liked by 1 person

    • Carolyn Thomas August 23, 2011 at 6:53 am #

      Hi Grandioz – Doctors are not necessarily saying “It’s just your imagination”. What they do seem to be saying is “It’s not your heart!” You’re right – patients need to be self-educated about the differences between diagnoses.
      Cheers,
      C

      Like

  7. Anon August 21, 2011 at 11:43 am #

    I am one of those people who showed up in the ER more than once mistakenly convinced I was having a fatal heart attack because of the scary symptoms you describe. Even without heart attack fears, the worst part was the common fear of having another panic attack. This went on for TWO YEARS before, thank God, I was referred to a wonderful therapist who helped me manage my panic and anxiety attacks. She helped me realize that every time I’d been to the ER absolutely convinced I was having a fatal heart attack, I had somehow survived. I hadn’t died, that time or the time before that or the time before that.

    Things are so much better now. I am like a different person now, although I think my temperament is by nature over-anxious about many things! The difference now is that I have learned some useful coping strategies, and now I use aerobic exercise, yoga, medication, or even singing (!) to help address times of anxiety or panic. I also starting volunteering at an animal shelter, and then my husband and I adopted a rescue dog from there two years ago. She has been a lifesaver and reminds me to be less preoccupied 24/7 with my own self, a trait that had unfortunately become “normalized” daily routine when you suffer from panic disorder.

    Thanks very much for this article. I urge anybody with panic attacks to seek a qualified mental health professional.

    Like

    • Carolyn Thomas August 21, 2011 at 6:07 pm #

      Thank you Anon for sharing your unique perspective, particularly those options to manage your panic/anxiety symptoms. Keep up the good work.
      Cheers,
      C

      Like

  8. Campykid August 15, 2011 at 2:37 pm #

    Sometimes the symptoms listed above indicate neither a heart attack or a panic attack.

    For 10 years before finally being correctly diagnosed with atrial fibrillation, I experienced: palpitations, pounding heart and accelerated heart rate, sweating, trembling/shaking, shortness of breath, chest pain/discomfort, feeling dizzy and lightheaded, and fatigue. My inexperienced (and former) PCP was convinced the symptoms were due to anxiety and a young cardiologist was quite dismissive (those pesky “women of a certain age”).

    Eventually my episodes were so frequent that A-Fib was captured on an ECG. Years later, I pulled my medical records and read that the 28 year old PCP had written I had “magical, mythical thinking” about my health.

    This journey forever changed how I deal with health care providers and taught me the value of being my own advocate.

    Like

    • Carolyn Thomas August 16, 2011 at 8:39 am #

      Ah, yes that “magical, mythical thinking” that makes heart patients believe they’re having heart problems… Congrats on becoming your own advocate – but it’s too bad that, for many of us, we have to go through a serious diagnosis first.

      Like

  9. Mary August 13, 2011 at 5:14 am #

    “Pain that is brought on by exertion (although unstable angina may bring about pain without exertion)”
    ***
    OK, gotta get in the mix with this one!
    ***
    The confusing part, particularly for women and MDs at the ER…in classic cardiac textbooks, it is well known that EMOTION is at least an equal provocateur to chest pain as EXERTION, but because the classic “Hollywood Heart Attack” is whilst shoveling the snow filled driveway, (a male tendency), the public is being wrongly conditioned. More to the point, Doctors are wrongly trained and biased.

    Females (and males) may well experience chest pain that is not anxiety in origin, yet so far at present, technologies cannot quantify small or microvascular disease easily. Troponin measurement may not be the only standard for validating a cardiac origin, which can be evolving over a long time and culminate after a prolonged period of ischemia for the heart. The lack of troponin or other physical evidence does not relieve the doctor from believing the patient, or typecasting the female as “emotional and anxious”. Women DO tend to be more emotional, but it doesn’t invalidate their chest pain!

    Very often, in the ER, several courses of functional testing might be pursued:

    1) The anesthetic/maalox cocktail – presumably, numbing the esophagus will not numb the chest pain.
    2) Xanax – presumably, if anxiety, the medication will prove the chest pain was psychogenic in origin.
    3) Nitro – the last to be administered because of the “terrible” headache, which “proves” it’s cardiac.

    In my several ER visits, I was only administered the nitro once (after diagnosis when I was believed). Previously, I *was* given Ativan. The pain subsided, ergo, diagnosed as “anxiety”. I will explain now, that nitro *does* relieve my chest pain and Xanax *does* assist greatly, not because of anxiety but because emotions (and the brain) contribute to vascular regulation. I *do* have genetic familial risk factors discovered far later than they should have been, and I *do* have abnormal and paradoxical ischemia, per provocative cath at a leading center. The anxiety that normally builds when experiencing severe chest pain would be NORMAL! And yes, anti-anxiety agents do help!

    Cardiac receptors in our heart and brain are interrelated to our millisecond by millisecond vascular response throughout our bodies. This vascular response (constriction and dilation) controls blood pressure regulation. Microvascular ischemia supporting the cardiac bed may NOT register on the EKG or any other measurement in an ER, as it is a very subtle and focal area yet can produce a high level of pain for some. Many women (and men) with MVD, small vessel disease, can fool the MD (This week, a study on theheart.org cites 60% of caths show no obstruction). As stated above, 40% experiencing MI do NOT report chest pain!

    I look forward to the day when the differential symptom is written this way:

    “Pain that is brought on by exertion or emotion” (and recognized as valid). Full stop.

    Like

    • Carolyn Thomas August 13, 2011 at 5:54 am #

      Hello Mary and thanks so much for your comment. Of course, you KNOW that I agree 100% with what you write about the physiology of heart disease – particularly in women. The focus of this post, however, is on those suffering from panic disorder whose panic is exacerbated by believing (wrongly) that their current acute symptoms mean heart attack. Ironically, U.K. studies suggest that the hyperventilation that occurs with panic attacks may trigger coronary artery spasm, leading to an acute cardiac event.

      Here’s my concern about stats like “41% of patients with panic disorder seek treatment because of frightening chest pain”: women like me (and you) are being sent home from the E.R. (despite genuine cardiac symptoms) by physicians who may have just spent an entire shift seeing a parade of panic attacks masquerading as heart attacks. This leads to US being patted on the head and sent home with an ‘It’s all in your head, dear!’ misdiagnosis.

      It’s a tough call: we certainly want more women to be accurately diagnosed, particularly with hard-to-catch cardiac culprits like microvascular disease, Prinzmetal’s, endothelial dysfunction, etc. But as long as those in mid-panic attack are clogging the E.R. because of their frightening chest pain, the rest of us will continue to be ignored/misdiagnosed. More on this at “Catastrophizing: Why We Feel Sicker Than We Actually Are”.

      cheers,
      C.

      Liked by 1 person

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