Panic Attacks: Why They Feel Like a Heart Attack and What a Visit Can Do

What it involves

MedlinePlus describes panic disorder as a type of anxiety disorder in which you have repeated attacks of intense fear that something bad will happen. An attack begins suddenly and most often peaks within 10 to 20 minutes, though some symptoms continue for an hour or more.

Who this is for

• Adults who have had sudden episodes of intense fear with a racing heart or shortness of breath
• Patients who went to an emergency room for chest symptoms and were told the heart looked normal
• People who now avoid places or activities for fear of another attack
• Anyone whose attacks are interfering with work, relationships or sleep

What to expect

• Questions about what happens during an attack, how long it lasts, how often it occurs and what you do afterward
• A physical exam, and an EKG at the Loxahatchee or West Palm Beach office when the symptoms call for a heart check
• Blood work to look for medical causes, such as thyroid problems, that can mimic panic
• A plan that can include talk therapy referral, treatment options and follow-up, with a clear safety plan for severe symptoms

What a panic attack feels like

MedlinePlus lists the symptoms of an attack, and says people with panic disorder have at least four of them during one: chest pain or discomfort, dizziness or feeling faint, fear of dying, fear of losing control or impending doom, a feeling of choking, feelings of detachment or unreality, nausea, numbness or tingling, palpitations or a pounding heart, a sensation of shortness of breath, sweating, chills or hot flashes, and trembling. An attack may be mistaken for a heart attack. The pattern that repeats from one attack to the next is what points toward panic.

Why the heart should be checked first

MedlinePlus says many people with panic disorder first seek treatment at the emergency room because an attack feels like a heart attack, and that other medical disorders must be checked for before panic disorder can be diagnosed. That is why a first visit usually includes a physical exam and, when chest symptoms are involved, an EKG, which the practice offers at its Loxahatchee and West Palm Beach offices. The heart palpitations guide and chest pain guide explain which symptoms need 911.

Other causes that can look like panic

Because symptoms can resemble panic attacks, MedlinePlus says disorders related to substance use are considered and blood tests may be done. An overactive thyroid, low blood sugar, caffeine, certain medicines and alcohol withdrawal can all produce a racing heart and shakiness. The thyroid blood tests guide and the low blood sugar guide describe two of them. Telling your provider exactly when the symptoms occur, such as after coffee or on an empty stomach, helps separate them.

What MedlinePlus says about treatment

The goal of treatment, according to MedlinePlus, is to help you function well in everyday life, and using both medicines and talk therapy works best. Cognitive-behavioral therapy teaches you to recognize and replace thoughts that fuel panic, to manage stress and to practice facing feared situations gradually. Medicines often also used for depression may help when taken daily, and the encyclopedia warns not to stop them without talking to your provider. Your provider can discuss which approach fits and refer you for therapy.

Habits that can lower the number of attacks

MedlinePlus suggests avoiding alcohol, eating at regular times, getting plenty of exercise, getting enough sleep, and reducing or avoiding caffeine, certain cold medicines and stimulants. It also lists support groups through the Anxiety and Depression Association of America and the National Institute of Mental Health as a helpful addition, though not a substitute for therapy or medicine. The broader anxiety symptoms guide and the depression screening guide cover the conditions that often travel with panic.

When to get help right away

Call 911 for chest pain that is crushing, spreads to the arm or jaw, or comes with fainting, because it can be a heart attack even in someone who has had panic attacks before. If you or someone you know is thinking about suicide, call or text 988, or chat at 988lifeline.org, which MedlinePlus lists as a free, confidential service available around the clock. Do not delay and do not leave the person alone. Attacks that are interfering with work, relationships or self-esteem are a reason to book a visit this week.

Sources

• MedlinePlus: Panic disorder (medical encyclopedia)
• MedlinePlus: Panic Disorder (health topic)