Sam Torbati, MD
Sam Torbati, MD, emergency medicine physician and medical director of the Ruth and Harry Roman Emergency Department at Cedars Sinai Hospital in Los Angeles.
You have a sudden onset of chest pain, trouble breathing, sweating, nausea, dizziness, and a terrifying sense of impending doom-the classic symptoms of a life-threatening heart attack. But they are also classic symptoms of a passing panic attack.
If you are having a heart attack, time is not on your side. The sooner you get to the emergency room (ER), the sooner they can get a stent in your heart and restore blood flow. Any delay means more damage to your heart muscle.
On the other hand, if it is just a panic attack, it will pass in about 20 minutes. You really don’t want to have an ambulance show up at your house or drop you at the ER with all your symptoms gone as quickly as they came. What should you do?
Unfortunately, there is not enough difference between symptoms of a heart attack and a panic attack for you to know what to do at home. Classic heart attack symptoms are new chest pain, shortness of breath, dizziness, and sweating. Classic heart attack chest pain is a sensation of tightness, squeezing, and heaviness, with pain radiating to your jaw or arm.
In a panic attack, chest pain may be less severe and limited to the front of your chest. However, many people with a heart attack have that type of chest pain, so the type of pain is not a reliable indicator.
Heart attack may be more likely if you are over age 40 and you have risk factors for a heart attack or you already know you have heart disease. Risk factors include a family history of heart attack, high blood pressure, diabetes, obesity, high cholesterol, and smoking.
The worst mistake you can make is to assume you are having a panic attack and show up at the ER hours later or the next day still having chest pain. By this time the damage is done. You may still get a stent placed, but the consequences of your heart attack may affect the rest of your life. It would have been much wiser to show up at the ER without any symptoms. You might feel a bit embarrassed, but your ER doctor would rather see you embarrassed than debilitated.
Don’t ever take a chance on driving to the ER. Calling 911 gets you there safely and quickly. Traffic will move out of the way. Paramedics can start treatment in the ambulance, and they can call ahead to get the ER and the stent room ready for you. This is the only way to fly when you might be having a heart attack.
A panic attack usually peaks and passes quickly. If you are under age 40 with no history of heart disease or risk factors, and you have a history of panic attacks in the past, you can try some relaxation techniques and deep breathing to see if your symptoms will pass. If they last longer than 20 to 30 minutes, call 911.
A panic attack is a sudden episode of intense fear when there is no apparent danger. Panic attacks are not life-threatening, even though they may feel that way. Symptoms peak within minutes. After the attack you may feel tired and drained. Even though you did not need to call 911, you should still call your doctor. Panic attacks tend to get worse and more frequent without treatment.
You may have heard that panic attacks come out of the blue when you are resting, but a heart attack usually occurs during exercise. That is true for chest pain called angina, but not for a heart attack. Most heart attacks occur without exertion or warning.
Finally, remember that the difference between a heart attack and a panic attack is not like the difference between a sprained ankle and a broken ankle. As they say in the ER, time is muscle. If in doubt, call 911.
