Anxiety vs heart attack: how to tell the difference, and when you can’t

Your chest is tight, your heart is pounding, you feel sick and sweaty, and a terrifying question fills your head: is this a panic attack, or a heart attack?

It’s one of the most common fears people with anxiety have, and it’s a reasonable one, because the two can feel remarkably alike. Here’s what doctors look for, why you can’t always tell at home, and what to do.

If you think you might be having a heart attack, call 911 (or your local emergency number) now, even if you’re not sure. Don’t drive yourself. Acting fast can save heart muscle and lives.

Why they feel so alike

Both switch on your body’s alarm system. A heart attack causes pain and distress that release adrenaline. A panic attack releases adrenaline first, and the body symptoms follow. Either way, you can get:

• chest pain, tightness or pressure
• a racing or pounding heart
• breathlessness
• sweating
• nausea
• light-headedness
• a sense of dread or doom

Heart attack symptoms

The US National Heart, Lung, and Blood Institute lists these symptoms of a heart attack:

• chest pain, heaviness or discomfort in the centre or left side of the chest (the most common symptom)
• pain or discomfort in one or both arms, your back, shoulders, neck, jaw or above your belly button
• shortness of breath at rest or with a little activity
• sweating a lot for no reason
• feeling unusually tired for no reason, sometimes for days (more common in women)
• nausea and vomiting
• light-headedness or sudden dizziness
• a rapid or irregular heartbeat

Importantly, it notes that not all heart attacks start with sudden, crushing chest pain. Symptoms can start slowly, be mild, or come and go over several hours, and some heart attacks have very mild symptoms or none at all, especially in older adults and people with diabetes.

Panic attack symptoms

A panic attack is a sudden surge of intense fear that peaks within minutes, with symptoms like a pounding heart, sweating, shaking, breathlessness, chest discomfort, nausea, dizziness, tingling, feeling unreal and fear of dying or losing control. Our full list of panic attack symptoms explains each one.

Patterns doctors notice

These are tendencies, not a test. Plenty of heart attacks don’t follow the typical pattern.

	More typical of a panic attack	More typical of a heart attack
How it starts	Suddenly, often at rest or with stress, sometimes out of the blue	Often with exertion, but can be at rest; may build slowly
The pain	Sharp, stabbing or tight, often in one spot	Pressure, squeezing, heaviness or fullness, often in the centre or left
Spreads?	Usually stays in the chest	Often to the arm, back, neck, jaw or upper belly
How long	Peaks within about 10 minutes, then eases	Lasts more than a few minutes, or comes and goes
Other signs	Tingling in hands or around the mouth, shaking, feeling unreal	Cold sweat, nausea, unusual tiredness, breathlessness on little effort
Who	Any age, often with a history of panic or anxiety	More likely with age, high blood pressure, diabetes, high cholesterol, smoking or family history

Why you can’t rely on the differences

• Heart attacks can be atypical, especially in women, older adults and people with diabetes, with breathlessness, nausea, back or jaw pain, or tiredness and little chest pain.
• Heart attacks also cause fear. Feeling panicky doesn’t rule one out.
• Having anxiety doesn’t protect your heart. In one study at a heart hospital, about 1 in 4 people who came to the emergency room with chest pain had panic disorder, and many of them also had heart disease.

So the safest rule is simple: if you’re not sure, call 911.

What happens at the hospital

Doctors will usually do a heart tracing (ECG) and blood tests for troponin, a protein released when heart muscle is damaged, and may monitor you for a while. Normal results can be a huge relief, and they make it easier to trust next time that a familiar pattern is panic.

Chest discomfort that isn’t a heart attack

Many things cause chest discomfort that isn’t a heart attack, including:

• anxiety and panic
• tense or strained chest muscles
• costochondritis, inflammation of the rib cartilage, which hurts more when you press on it or move
• acid reflux, a burning feeling behind the breastbone
• chest infections

Some non-heart-attack causes are still emergencies, like a blood clot in the lung (sudden breathlessness, pain on breathing in, coughing up blood) or a tear in the main artery (sudden tearing pain spreading to the back). Others, like angina and pericarditis, are heart-related and need a doctor. Our post on why your chest might feel tight goes through the causes.

If you’ve been checked and it was panic

• Learn your usual pattern. Note what your panic chest pain feels like. If it ever feels different, stronger or comes with new symptoms, get checked again.
• Use your calming skills: a long, slow out-breath, grounding and letting the wave pass.
• Watch the checking. Repeatedly checking your pulse, pressing your chest or searching symptoms keeps the fear going.
• Treat the panic. Cognitive behavioural therapy (CBT) helps most people with panic attacks and the fear of heart problems that comes with them.

Frequently asked questions

How can I tell if it’s anxiety or a heart attack?

You often can’t, reliably, at home. Panic tends to come on suddenly, peak within about 10 minutes and come with tingling or shaking. Heart attacks more often cause pressure that spreads to the arm, jaw or back, lasts longer and comes with a cold sweat or nausea. But there’s lots of overlap. If you’re unsure, call 911.

Can a panic attack feel like a heart attack?

Yes, very much. Chest pain, a racing heart, breathlessness, sweating and a fear of dying are all common in panic attacks. That’s why so many people with panic go to the emergency room thinking it’s their heart.

Can anxiety cause a heart attack?

A panic attack doesn’t usually harm a healthy heart. But intense stress can trigger heart problems in people who already have heart disease, and having anxiety doesn’t protect you from heart disease. That’s why new or different chest pain should always be checked.

Should I go to the ER if I think it’s just anxiety?

If it’s new, different or severe, or you’re not sure, yes. If a doctor has checked you before and this feels exactly like your usual panic, you can try slow breathing first. If anything feels different, get help.

How Breatheasy can help

Once a doctor has checked you and you know your panic pattern, Breatheasy can help you ride it out. Tap “I’m feeling anxious” and Luma walks you through it: rate how strong it feels, breathe slowly as your phone pulses gently, ground yourself with 5-4-3-2-1, then see how far the anxiety came down. Seeing it fall each time helps your brain learn that familiar panic passes. Breatheasy can’t tell a panic attack from a heart attack, so if you’re ever unsure, call 911 first. Breatheasy is coming soon to iPhone and Android.

Sources

• Heart attack symptoms, National Heart, Lung, and Blood Institute
• Heart attack symptoms, NHS
• Panic disorder in emergency department chest pain patients, Fleet and others, The American Journal of Medicine, 1996
• Panic disorder, NHS
• Chest pain, NHS
• Costochondritis, NHS
• Pulmonary embolism, NHS