A 50-something man clutches his chest and collapses. This classic heart attack presentation may be common in the movies, but in real life the signs are not always as obvious. They are also commonly confused with panic attacks.

And understandably so. There are many similarities between the symptoms of a heart attack and a panic attack. “Unfortunately, when the nerves inform the brain of an injury to an organ, they are not always capable of distinguishing the location accurately,” says Dr. Ian Riddock, an internist and board-certified cardiologist at Summit Health. “It’s kind of like pulling a fire alarm,” he adds. “All of the alerts and signals go off but narrowing down the precise location is challenging since the sensations can feel like they’re coming from many other places in the body, or the signals themselves may feel similar to problems one has experienced with other organs, such as heartburn or muscle ache.” When in doubt, or if you are having pain lasting more than 15 minutes or so, it is probably worth getting evaluated at an urgent care or hospital.

Signs and Symptoms of a Heart Attack vs. Panic Attack

Both heart attacks and panic attacks are unfortunately very common—and very real. Every 43 seconds someone in the U.S. has a heart attack. Panic attacks affect at least 1 in every 10 adults each year, though physicians say they have been on the rise throughout the pandemic.

To begin to understand the difference between heart and panic attacks, imagine these two general scenarios.

Patient one is a middle-aged man who is overweight. While he is shoveling snow, a squeezing pain develops on the left side of his chest. As he walks inside, the man has trouble catching his breath. The feeling does not get any better when he sits down. In fact, the man starts to feel nauseous and is sweating through his shirt. These are classic symptoms of a heart attack, which are commonly referred to as “angina”.

Signs of a heart attack include:

  • A feeling of pain, pressure, or squeezing in the chest
  • Discomfort or pain in the arm, back, neck, or jaw
  • Shortness of breath
  • Nausea or vomiting
  • Lightheadedness
  • Breaking out in a cold sweat

Angina is brought on by a lack of blood flow to the heart muscle due to a physical blockage in the coronary arteries which deliver the blood. A “sudden” heart attack occurs when a cholesterol plaque along the inner wall of the artery ruptures (like a pimple) and a clot forms that shuts down or narrows the channel.

More chronic forms of angina are not due to a sudden rupture of the plaque but are due to gradual build-up of the plaque, to the point where it physically obstructs passage of blood to the heart muscle. Since the heart muscle needs more oxygen when working hard, the symptoms may only be initially noticeable when exerting oneself.

Patient two is a young woman who is on a tight deadline at work. She begins to feel as though her heart is beating out of her chest. As she walks over to the couch she becomes short of breath. Her palms are sweating and there is a tingling sensation in her hands. After she sits down for 20 minutes the woman starts to feel better. These are common signs of a panic attack.

Symptoms of a panic attack include:

  • Racing heartbeat
  • Feeling weak or dizzy
  • Difficulty breathing or hyperventilating
  • Tingling or numbness in the hands
  • Sweating or chills
  • Sense of impending doom

Clues to Tell the Difference

Here are a few tips that can help you differentiate between a heart and panic attack.

  1. Provocation – What triggered the attack? While a heart attack can occur randomly, at any time, a higher workload placed on the heart, such as physical exertion, will make angina feel worse. In the unconditioned individual, heart attacks can be triggered by unfamiliar or heavier than usual exertion such as shoveling snow or participation in vigorous activities without proper training or screening such as a marathon or pickle ball. In comparison, a panic attack commonly occurs when you are resting, sitting down, or even in the middle of the night, and is not typically made worse with exertion.

David Downing, PsyD, a member of Summit Health’s behavioral health team, says, “A panic attack is a strong emotional reaction, typically accompanied by symptoms of intense anxiety. It’s not necessarily related to a situation where you have overexerted yourself physically.”

  1. Duration – How long does the feeling last? If you are experiencing a heart attack, the chest pain and shortness of breath symptoms are not fleeting but are generally present for several minutes to hours. Symptoms typically get worse as the minutes go by, but in some cases are relieved with rest, or may come and go. The symptoms of a panic attack, however, usually present suddenly, peak over a few minutes and then subside after about 20 minutes and typically do not come and go.
  2. Localization and radiation – Can you pinpoint the area of discomfort and where it radiates? In a panic attack, individuals usually describe generalized tightness across the entire chest. A heart attack tends to involve a tightness, squeezing, pressure or aching sensation across the chest, with radiation to the shoulders, between the shoulder blades and up into the jaw and/or down the arms.

In general, people experiencing a panic attack describe more of a vague sense of impending doom that is then accompanied by a variety of symptoms. They may also experience tingling of the lips or tongue and fingertips from hyperventilation.

  1. Medical history – Do you have risk factors? An individual without any red flags can certainly have a heart attack, but clues to a higher risk are smoking, obesity, diabetes, high blood pressure, high cholesterol, and a family history of heart disease. Panic attacks are more common in individuals who are under a lot of stress at work or home, or those who suffer from anxiety and depression.

Women and Heart Attacks

For women, it can be even more difficult to differentiate because the symptoms of a heart attack may be less obvious. Women are sometimes mistakenly under the impression — by themselves and by health care workers — that they are at lower risk than men. This false impression can result in a delay in recognition, diagnosis, and proper treatment.

Patient three is a 50-year-old woman in fairly good health. She has been feeling unusually tired this past week. While walking the dog, she begins to feel lightheaded and nauseous. She notices a nagging feeling in her upper abdomen and thinks she must  be coming down with something.

Women may not experience chest pressure when they have a heart attack. Instead, symptoms might include:

  • Shortness of breath
  • Fatigue
  • Lightheadedness or fainting
  • Pressure or pain in the lower chest, upper abdomen, back, or jaw.

How the Experts Can Help

Even though a heart attack is medical in nature and a panic attack is behavioral, both problems are serious and cause the body to have physical responses.

During a heart attack, blood flow to the heart is either reduced or interrupted entirely. In a panic attack, the body’s fight or flight response kicks into high gear and adrenaline surges.

The sense of impending doom—this feeling like you are going to die—is quite real during a panic attack. “This is what leads people with panic attacks to visit the emergency room before they come see a therapist,” explains Dr. Downing.

With rates of anxiety and depression on the rise, panic attacks have become increasingly common throughout the pandemic. But patients can learn to have control over their panic attacks, and behavioral health clinicians are available to teach people the tools they need to prevent and manage panic attacks.

Dr. Riddock and team are also here to help. “It’s important for patients to listen to their bodies and come in for a medical evaluation when they are unsure.”

Ignoring heart attack symptoms can be fatal. If you are uncertain your symptoms are a sign of a heart attack, seek immediate medical attention.