How can I tell a panic attack from a heart attack?

Question

A panic attack (ghabrahat ka daura) can bring a racing heart, chest pain and a fear of dying, so people often fear it is a heart attack. They ask how to tell the two apart, and when chest pain needs emergency care.

DoctorOS Team · Answer

You often can't tell them apart on your own, because both can cause chest pain, breathlessness, nausea and a feeling of doom. If chest pain is new, feels like pressure or squeezing, or spreads to your arm, neck or jaw, treat it as a heart attack (dil ka daura) and get emergency help. Once a doctor has checked your heart, panic attacks can be treated.

Signs that point to a heart attack

Chest pain that feels like crushing, squeezing or pressure, or a burning feeling like indigestion (NHS).
Pain that spreads to the arm, neck or jaw (NHS).
Pain that comes on with physical effort, or pain that may change but does not go away (Cleveland Clinic).
Sweating, feeling sick, shortness of breath, or pale, blue or grey skin (NHS).

Signs that point to a panic attack

A racing heartbeat (dil ki dhadkan tez), trembling, sweating, dizziness (chakkar), a churning stomach or chest pain (NHS).
Sharp or stabbing pain that stays in the chest (Cleveland Clinic).
An emotional trigger rather than exercise (Cleveland Clinic).
Symptoms that peak and then pass. Most panic attacks last 5 to 20 minutes (NHS), although Cleveland Clinic says symptoms can last up to an hour.

These are clues, not a test. Cleveland Clinic warns that waking up with chest pain when you have never had a panic attack may be a heart attack, and advises immediate care whenever you are unsure. Having had panic attacks before does not make new chest pain safe to ignore.

During a panic attack

If a doctor has already ruled out a heart problem, stay where you are if you can, and breathe slowly and deeply (NHS). The attack will pass.

When to see a doctor

See a doctor if panic attacks keep coming back. A GP may examine you first to rule out other causes (NHS). The main treatments are talking therapy, usually cognitive behavioural therapy (CBT), and medicines such as SSRI antidepressants, which a doctor prescribes (NHS). For talking therapy, see a psychologist. Our guide to depression and anxiety explains where else to get help.

Emergency signs

Call Rescue 1122 or Edhi 115 straight away for chest pain (seene mein dard) that feels tight, crushing or squeezing, or pain that spreads to the arm, neck or jaw (NHS). Call too if you are unsure, and do not drive yourself to hospital (NHS). Our guide to heart attack warning signs has more.

Sources

General health information from the DoctorOS Team, not a diagnosis. For advice about your own situation, see a doctor.