The night before an exam, Akanksha (name changed), a medical student in Mangaluru, lay down on her bed but couldn’t fall asleep. Disturbing thoughts swirled around in her mind. Suddenly, there was a heaviness, like a weight pressing down on her chest. She felt as if an electric current was passing through her body. She was hyper-aware. She had palpitations too, but not very pronounced.
“I didn’t know what was happening,” says Akanksha. “I thought something was wrong with my heart. When you are in the medical field, you immediately think of a bigger diagnosis.”
Even outside of the field of medicine, people who experience a panic attack usually mistake it for a heart attack because the symptoms of both are very similar.
“Patients usually run to the emergency room [when they have a panic attack],” says Dr Arun Bhat P, assistant professor of psychiatry at KS Hegde Medical Academy, Mangaluru. “They undergo ECG and other tests and are told that it isn’t a heart attack. When they experience another attack, they feel that the test results were wrong, and they go to the hospital again. This becomes a loop, a habit for them.”
A major difference between the two is that a heart attack can be fatal while a panic attack is not life-threatening. But it is often difficult to differentiate between the two while experiencing the symptoms.
Difference between panic attack and heart attack
A heart attack usually occurs when plaque (build-up of fat, cholesterol and other substances) in the coronary arteries ruptures and forms a clot, restricting or cutting off the supply of blood to the heart. The condition where the arteries narrow and harden because of plaque is known as atherosclerosis.
According to the World Health Organization, cardiovascular diseases (CVD) are the leading cause of death globally. Out of every five deaths due to CVD, more than four occur because of heart attacks and stroke; and a third of these are premature deaths in those aged below 70.
A panic attack, on the other hand, is a sudden episode of overwhelming fear or anxiety accompanied by several physical reactions with no obvious cause. While panic attacks aren’t fatal, they may negatively affect the quality of life. Anyone can have a panic attack. Usually, people have their first panic attack in their adolescence or as young adults, but people across ages can experience them.
“They feel like they are going to die,” Dr Bhat. “Panic attacks have a varied picture. Some people complain of chest pain, palpitations and a feeling of doom.”
Signs of panic attack vs heart attack
Dr Bhat says that a heart attack may have symptoms like those of a panic attack, but more specific, such as chest pain, discomfort in the chest, sweating, gastritis and vomiting. Panic attacks have a psychological component of anxiety — like the feeling of impending doom (as if something bad is going to happen) and feeling like they are going to die.
There is also a physical component to panic attacks which includes symptoms like chest pain, palpitations and breathlessness. They can also have gastrointestinal discomfort, feeling like passing stools and urine, giddiness, blurring of vision, tremors of the hand, sweating, having pins-and-needles sensations across the body.
Physical exertion may sometimes cause or worsen a heart attack. It is best to take any chest pain caused by exertion seriously. On the other hand, panic attacks usually occur randomly and for no reason; but they may also occur due to psychological distress, such as in the case of phobias. A person with an intense fear of heights or closed spaces might experience a panic attack when standing on a cliff or inside small spaces like an elevator.
Akanksha speaks about what she thinks might have triggered her panic attack. “I’m a very anxious person,” she says. “My mother was diagnosed with cancer and my parents had kept it from me. But I could make out that something was wrong – when we spoke on the phone, her voice used to be raspy. I used to score well. I was a topper. I was in my final year of MBBS. I was also an editor of the college magazine. I had multiple stressors. Maybe, beyond a point, I couldn’t handle them.”
Time is an important differentiator. A panic attack begins suddenly and peaks in intensity after around 10 minutes. Typically, attacks subside within 30 minutes. In a heart attack, symptoms may be felt for over a few minutes, on and off. Sometimes, people experience symptoms for hours, days or weeks in advance. A recurring and persistent chest pain needs to be addressed as soon as possible.
Dr Bhat notes that chest pain and other symptoms of a panic attack are not that easy to interpret. “Many illnesses overlap with a panic attack,” he says. “When sugar levels drop in diabetics, symptoms like a panic attack can be observed; similarly, when adrenaline shoots up. Others like mitral valve prolapse, cardiac problems and pheochromocytoma must be ruled out.”
So, if you are experiencing symptoms like chest pain, shortness of breath and a feeling of impending doom, and you are not sure about whether it is a heart attack or panic attack, it may be the best course of action to dial the emergency helpline number or rush to the nearest hospital and get yourself tested to rule out any other possibilities. It is, after all, better to be safe than sorry.