How to tell the difference between a heart attack and a panic attack

This article was updated on July 27, 2021.

Your heart is racing, and you feel pain in your chest. Is it a heart attack or a panic attack?

Distinguishing between the two can be difficult, especially if you've never experienced either, said William Meurer, M.D., of the University of Michigan Health System Emergency Department. "There's an overlap in symptoms associated with heart attack and panic attack."

To further complicate things, the stress and anxiety that often cause panic attacks can also lead to heart attacks. "It's a complicated relationship," he said.

'Maximize' your symptoms

"People often blame their symptoms on stress. They minimize versus maximize their symptoms. 'Maybe I'm OK,' they tell themselves. But their situation may escalate very quickly," said Meurer.

"The important thing is to seek medical attention if you're not sure about your health. Be vigilant, and get checked out promptly. If you're worried that it's a heart attack, call 911 to get an immediate evaluation."

If you're experiencing an episode that is similar to one you've had in the past that turned out to be stress-related, Meurer recommends practicing deep breathing or meditation to see if the symptoms subside. "If they don't, seek medical help," he said.

James Froehlich, M.D., U-M Frankel Cardiovascular Center cardiologist, agrees.

"Heart attacks are already often missed, and we don't want to discourage anyone who thinks they might be having a heart attack from getting checked out."

He also advises his patients to stay on their regular heart medications, even if they are feeling good and think they can stop taking them. "Preventive medications are very effective. If you keep up your meds, you may never know about the heart attack you didn't have."

What to look for

The two conditions can appear similar, but there are some key differences.

Heart attack symptoms include:

• Escalating chest pain that reaches maximum severity after a few minutes
• Constant pain, pressure, fullness or aching in the 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
• Pain that is brought on by exertion
• Shortness of breath

Panic attack symptoms include:

• Increased heart rate
• Sharp or stabbing chest pain that lasts only 5 to 10 seconds
• 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

The bottom line: "Be vigilant and get checked out promptly," said Meurer. "If you think it's a heart attack, call 911 to get an immediate evaluation."