Distinguishing between a panic attack and a heart attack

People who have panic attacks commonly fear that they are having a heart attack. This fear makes the panic anxiety worse. As some of the symptoms of a panic attack are also experienced during a heart attack (eg chest pain), it is understandable that people may mix them up. If chest pain is recurrent or long-lasting, it is wise to have a thorough medical investigation. However, if your doctor has ruled out heart disease, then it is very unlikely that subsequent chest pain is caused by a heart attack. The information below may be helpful in telling the symptoms of panic and a heart attack apart.

Ischaemic heart disease is very rare in young women. Young women are the group most likely to experience panic disorder. Heart disease does NOT cause panic attacks and panic attacks do NOT cause heart disease.

Generally, if you are prone to panic attacks and you experience another similar attack, it is probably best for you to sit quietly and use the slow breathing exercise for about five to ten minutes. It may also be helpful to ask yourself "Did I die or have a heart attack the last time I experienced these symptoms?"

However, if the pain is still present after ten minutes of slow breathing, you are advised to seek medical advice.

-	HEART ATTACK	PANIC ATTACK
PAIN	May or may not be present If present, the pain is often described as a crushing feeling (like someone standing on the chest) This pain is usually located in the central chest and may extend to the left arm, neck and back. Pain, if present, is not usually made worse by breathing or by pressing on the chest. Pain, if present, is usually persistent and lasts longer than 5-10 minutes	Any pain is usually described as 'sharp' The pain tends to be localised over the heart Pain is usually made worse by breathing in and out and pressing on the centre of the chest Pain usually disappears within about 5-10 minutes
TINGLING	Tingling, if present, is usually in the left arm	Tingling is usually present all over the body
VOMITING	Common	Nausea may be present but vomiting is less common
BREATHING	A heart attack does not cause you to breath too quickly or too deeply (hyperventilation) - panic does. With a heart attack you may feel a little short of breath. It is possible however, to have a heart attack and then start panicking. In this case, hyperventilation is a symptom of panic not of the heart attack	Breathing too quickly or too deeply (hyperventilation) is an extremely common panic response which precedes most panic attacks

Adapted from Andrews G and Jenkins R, 1998, Managing Mental Disorders, (UK Edition) Sydney, World Health Organization Collaborating Centre for Mental Health and Substance Abuse.

Page updated:

Distinguishing between a panic attack and a heart attack