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How to Tell the Difference Between Panic and Heart Attacks

If you feel cardiac symptoms during times of high anxiety, you’re not alone. Here’s how to navigate heart health with an anxiety disorder.

More than 40 million adults in the U.S. have an anxiety disorder. While stress, anxiety and panic experiences are different for everyone, one of the most common ways these feelings manifest is through cardiac symptoms.  

“The body can respond physically to stress and anxiety in a number of ways,” says cardiologist Talya Spivack, MD. “When stress hormones are elevated, your blood pressure may rise and you may feel heart palpitations, a racing heartbeat, shortness of breath, or even chest pain. In extreme cases, stress can also cause the heart to temporarily weaken, a condition called stress-induced cardiomyopathy.”  

It can be hard to decipher if your cardiac symptoms are caused by anxiety or another condition, like heart disease. Here’s what you need to know about anxiety and heart conditions, and when to seek medical attention: 

When Panic Attacks Mimic Heart Attacks  

Those with an anxiety disorder have most likely experienced a panic or anxiety attack at some point in their lives. The symptoms can closely mimic heart attacks for some people—they may feel chest pain, shortness of breath and heart palpitations, or a racing heartbeat.  

“If someone experiences symptoms like this for the first time, the safest thing to do is seek medical attention immediately,” says Dr. Spivack. “As physicians, we never presume first that anxiety is the cause. It’s a diagnosis that we make once we rule out other conditions.” She advises patients who develop acute symptoms to see a medical professional as soon as possible for testing and evaluation. 

Anxiety and Underlying Heart Disease   

While anxiety or panic attacks can mimic heart attack symptoms, there’s also the possibility that chronic anxiety can have a long-term effect on the heart health of those with underlying disease. “Anxiety doesn’t necessarily cause heart disease, but it certainly doesn’t help it. For those who have an underlying cardiac condition, anxiety or a panic attack can exacerbate underlying cardiac problems and even trigger events,” says Dr. Spivack.  

Elevated blood pressure and stress hormone levels can also exacerbate existing coronary artery disease, blockages or other cardiac conditions.  

How to Balance Anxiety and Heart Health  

If you experience cardiac symptoms, whether serious or mild, it is important to visit a cardiologist to rule out heart disease. “If the heart is operating normally, we’ll try to identify emotional and situational triggers to minimize future panic attacks,” says Dr. Spivack. “It’s helpful to observe what’s going on around you when you experience symptoms: Are you exercising, feeling stressed about something, or just lying in bed? Sharing these details with your provider can help us navigate treatment options and further diagnostic testing.”  

Dr. Spivack recommends practicing relaxation techniques and mindful meditation to help in the event of an anxiety or panic attack. “If you’re having these events frequently, talk to your primary care provider about it. They’ll be able to guide you through options like mood-stabilizing medications, cognitive behavioral therapy or other mental health treatments,” she says.  

The most important thing to know about anxiety and the heart is that you are not alone. “Many people have been feeling more anxious during the pandemic—it’s an incredibly stressful time,” Dr. Spivack shares. “Don’t feel embarrassed to tell your doctor what’s going on with your heart. No matter what the underlying cause, what you’re feeling is real, and we’re here to help.”  

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