Is it a heart attack – or a panic attack?

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 20–26.

See also:

• Top 25 treatments for anxiety
• Are you a ‘health seeker’ or a ‘disease seeker’?
• When your doctor mislabels you as an “anxious female”
• “Catastrophizing” – why we feel sicker than we actually are