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

The symptoms come on quickly: You feel your chest tighten, your heart rate skyrockets and you start sweating. 

It’s an alarming scenario, and your mind races to figure out what’s happening. Is it a heart attack? Or is it a panic attack? It can often be difficult to tell the difference (especially if you’ve had neither) and that only adds to the confusion and stress.

Both events are serious and it’s important to recognize which one you’re experiencing so you can get proper treatment. Cardiologist Mistyann-Blue Miller, MD, explains what these two conditions have in common and how they’re different.

What are the symptoms of a heart attack?

A heart attack is when part of your heart doesn’t get enough blood. This usually happens because an artery that supplies blood to the heart is blocked. Common heart attack symptoms include:

• Chest pain or pressure.
• Pounding or racing heart.
• Feeling lightheaded or faint.
• Sweating, including cold sweats.
• Pain or discomfort in the upper body, such as the jaw, neck, arms, shoulders or back.
• Shortness of breath.
• Nausea or vomiting.
• Feeling of impending doom.

A heart attack can be life-threatening, so don’t wait to see if the symptoms go away. Seek immediate medical care if you have signs of a heart attack.

What are the symptoms of a panic attack?

A panic attack is a sudden attack of overwhelming fear or anxiety. Panic attacks are not life-threatening, but they interfere with your quality of life and mental well-being.

People who have regular or frequent panic attacks may have a panic disorder, a type of anxiety disorder. But an isolated panic attack can happen to anyone, even without a panic disorder diagnosis. 

Symptoms of a panic attack include:

• Sudden feelings of strong anxiety and fear.
• Chest pain.
• Trouble breathing.
• Feeling of impending doom.
• Pounding or racing heart.
• Sweating.
• Shaking or trembling.
• Weakness or dizziness.
• Stomach pain or nausea.

The difference between a panic attack and a heart attack

The symptoms of these two conditions can be alarmingly similar. Dr. Miller discusses the main differences so you can tell them apart:

Location of pain

Both panic and heart attacks cause chest discomfort, but there is a difference. “With a heart attack, pain radiates to other areas like the arm, jaw or neck,” Dr. Miller says. “If it’s a panic attack,” she notes, “pain will typically stay in the chest.”

How the chest pain feels

Heart attacks feel like:

• Chest pressure.
• Feeling of squeezing or, says Dr. Miller, “like an elephant sitting on your chest.”
• Achy or burning sensation, like heartburn.

Panic attacks often cause:

• Sharp or stabbing pain (not typical with a heart attack).
• Heart racing or chest discomfort that’s hard to describe.

The triggers

Heart attacks tend to happen after physical strain or exertion — a sign not found in panic attacks. “A heart attack might happen after shoveling snow or walking up a long flight of stairs,” Dr. Miller says. “But you wouldn’t have a panic attack after exercise unless there was an emotional stress trigger with it.”

But what if the symptoms hit you at night? Both panic attacks and heart attacks can wake you from sleep. But there’s a key difference: People who have nighttime, or nocturnal, panic attacks usually have daytime panic attacks, too.

So if you wake up with chest pain or other symptoms, and you don’t have a history of panic attacks, that might be a sign of a heart attack.

How long it lasts

Panic attack symptoms last a few minutes or up to an hour. Then, the symptoms disappear, and you feel better. But a heart attack won’t let up.

Pain and symptoms of a heart attack might keep going or come in waves where it gets better and worse. “Heart attacks can cause severe chest pain, like a 9 or 10 on the pain scale,” says Dr. Miller. “Then later, the pain may drop to a 3 or 4 before it gets worse again. The pain might change, but it won’t go away.”

What happens to your heart rate during a panic attack?

In many cases, a panic attack triggers a fast heart rate, also known as tachycardia. The heart rate may speed up to 200 beats per minute or even faster.

A fast heart rate can make you feel lightheaded and short of breath. Or you might feel fluttering or pounding in the chest. Usually, tachycardia that happens in response to emotional stress and only lasts a few minutes is not harmful. But if it happens regularly, or you have possible symptoms of a heart attack, seek medical care.

Can a panic attack cause a heart attack?

A panic attack is unlikely to cause a heart attack, but it’s possible. Emotional stress plays a role in both conditions. “Both panic attacks and heart attacks can occur during or after a stressful situation,” says Dr. Miller. “But most of the time, people have a panic attack rather than a heart attack in response to emotional stress.”

People who have anxiety, depression or chronic stress may have a higher risk of heart problems. Chronic stress can lead to high blood pressure, which raises the risk of heart attack and stroke.

Watch for subtle signs of a heart attack

A heart attack might seem like it came out of nowhere. But in many cases, chest pain due to heart disease, known as angina, appears in the days or weeks before a cardiac event.

“You may feel a twinge or some pain in the shoulder or chest but think it’s something else,” says Dr. Miller. “The symptoms go away. Then later, the pain gets worse, or you feel a little off. Then the heart attack hits. These early signs can be hard to identify.”

Play it safe with chest pain and heart attack symptoms

A heart attack is a medical emergency. A panic attack isn’t. But with the overlap in symptoms, it can be tough to tell them apart. Don’t take chances. If you have chest pain or other heart attack symptoms — or if you’re not sure if it’s a heart attack or panic attack — seek immediate medical care.