#050 Is it a Panic Attack or a Heart Attack?

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Is it a Panic Attack or a Heart Attack?

On a Saturday night many years ago, Mary suddenly felt a pain in her chest and her heart was racing.  She immediately thought, this is it I must be having a heart attack. Am I going to die?  She was naturally very anxious while this was happening.

Her husband immediately dialed 911.  Just as the paramedics arrived to her house her symptoms started to ease up.  The paramedics hooked her up to an EKG machine and her heart rhythm was back to normal.  For precaution, they took her by ambulance to the ER.

As they could find nothing wrong with her she was given the diagnosis of panic attacks.  For many years she was given many anti-anxiety medications but nothing seemed to work.  Despite a normal stress test her intermittent symptoms of chest pain and rapid heart beat just kept getting worse.

She thought she was losing her mind and none of her doctors could figure out what was going on.  That was until last Saturday night.  This time it was different.  The pain was much worse and this time her heart did not stop beating fast.

Once again her husband called 911 and this time when they hooked her up to an EKG they saw that her heart was in an abnormal rhythm called supraventricular tachycardia (SVT) and it was beating at 240 beats per minute.

The paramedics immediately gave her an intravenous medication, adenosine, to stop her heart and get it back to normal rhythm.  For many years she had been prescribed anti-anxiety medications for these very same symptoms when in reality the problem was that she had an intermittent heart arrhythmia.

Is it any wonder she panicked during these episodes?  I would panic too if my heart was beating at 240 beats per minute!  Fortunately, once the diagnosis was made, I was able to perform a simple procedure, called an SVT catheter ablation, which allowed her to be cured of this heart condition.  Best of all she no longer needs drugs for anxiety!

This is not an isolated experience.  Rather this is something that I see every week in my cardiology practice.  Generally, it is a younger woman with a cardiac arrhythmia who is misdiagnosed as having panic attacks.

Three Steps to Answer Is it a Panic Attack or a Heart Attack

Since the symptoms of a panic attack and a heart attack are often the same, how can you tell the difference?  Let me give you three things to consider when trying to determine if the intermittent chest pain, rapid heart beat, and anxiety are coming from the heart or not.

1. Don’t ignore your symptoms.

If it really is a heart attack then any delay in getting to the hospital could mean the difference between life and death.  Don’t delay in getting to the hospital, dial 911 if you think you might be having a heart attack.

2. Get a stress test

A simple stress test can help to determine whether or not you have a significant blockage in the arteries of your heart or a different heart condition.  My favorite stress test to perform is a stress echocardiogram or “stress echo”.  I like a stress echo because there is no radiation, no IV in your arm, and it gives you so much more information like heart chamber sizes, heart valve function, etc.

While a normal stress test can make the likelihood of a heart attack very low, it does not rule out an abnormal heart rhythm or arrhythmia problem.  One thing to remember is that in women life stressors can trigger heart attacks.  Mental stress is not fully evaluated with the standard stress test.  If you are under a lot of mental stress this is something that you will need to discuss with your physician.  To rule out an arrhythmia issue you will need an EKG while your heart is beating fast and while you are having symptoms.

3. Get an EKG During the Attack

As heart arrhythmias like SVT or atrial fibrillation are often misdiagnosed as panic attacks in women, it is critical that you get an EKG while you are having symptoms.  Unfortunately, “Murphy’s Law” dictates that your heart rhythm will probably return back to normal before you can rush in to the ER fast enough for an EKG.

As arrhythmias are often episodic, the best way to diagnose this is to have your doctor prescribe a Holter monitor or an event monitor.  A Holter monitor is a monitor that is attached to your chest for 24 to 48 hours.  If your rapid heart beats happen during this period of time then you can easily make the diagnosis.

For people whose symptoms may only happen once or twice a month, the event monitor is usually the better test to order.  Generally speaking, the event monitor is prescribed to you for one month.  You take it off when you shower or go swimming.  The rest of the time your heart is being continuously monitored.

Even with a month long event monitor many people will not have any attacks during this month.  Fortunately, we now have newer options.  For example, the company Alivecor makes an FDA-approved EKG machine for the iPhone and the Android smart phone (I have no financial relationship with this company).

For $199 and a doctor’s prescription you can have your own EKG machine on your smart phone.  As most people always keep their phones with them at all times now you won’t miss this diagnosis.  Currently, I have about 30 patients using this device and all of them have recorded high quality EKG rhythm strips for me to review.

There you have it, my three simple steps to determine is it a panic attack or a heart attack.  Do you suffer from chest pain, rapid heart beat, and anxiety?

 

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11 Comments
  1. Hi Dr. Oh since my Dr doesn’t really explain he just says your fine it’s fine that doesn’t help me. I wouldn’t keep asking if it’s explained once and correctly. Can you tell me what these means so I can have peace of mind please. “There is systolic flattening of the mitral valve leaflets without definite prolapse”

    • Hi Barbara,

      It sounds to me like the report says that there is possible prolapse of the mitral valve. You may need to find a different cardiologist that can better explain things with you.

      Hope this helps!

      John

  2. Hi Doc, I had almost the same symptoms I woke up out of a dead sleep I felt my heart skipping and it wouldn’t go back to normal then bam for about a good 20 min was super fast I called 911 and sat on couch and waited then all of sudden it just stopped out of no where it felt like my heart was beating all over the place. Had all test done dr wasn’t sure maybe afib or Svt. Only happened when I went back on my lexapro I think it was the med because it says post marketing “afib” do you think it could have caused that? I have the alivecore and it’s great no afib just sinus tachycardia and pacs when I gave a panic attack. All ekgs stress test each normal Ef 65 and mild leaflet flattening of the mv.

    • Hi Barbara,

      Hard to say what was going on that day…Afib, SVT, sinus tachycardia…

      Fortunately, it seems to have stopped. It is possible that Lexapro was the cause. Only time will tell. If it does happen again you are certainly in a good position to record the EKG with your Alivecor monitor for your physician.

      Hopefully it never comes back!

      John

  3. Hi Doc,

    In your article, you have described the exact situation I found myself in. I had my first SVT attack when I was 19 and they would only last about 5-10 minutes before my heart would revert itself back to sinus. I was told that I had anxiety and panic attacks. I was referred to a psychiatrist. I used Celexa and Xanax for 5 years non-stop. I had SVT attacks 5-6 times a year. My entire personality changed during these 5 years. I used to an active and happy person. I stopped exercising, I stopped eating normally because I was afraid of post prandial heart rate elevations which is totally normal because of digestion but I did not like that elevation because I was afraid. One day my SVT decided to last 20 minutes and paramedics caught it. I was referred to an EP Specialist. Had EP study and ablation done. It turns out I had AVNTR’s which according to my doctor was very easy to ablate. It’s been 1 year since my operation. I am now 26 years old. I am not taking any medication anymore but mental scars are there and I am still afraid of exercising even though my cardiologist told me that my heart is perfect. Best years of my life was wasted with fear of death. I am going to cognitive behavioral therapy to be “normal” again. Thank you for putting this article. I hope this will help those who are misdiagnosed as well.

    Thank you,

    • Hi Efe,

      Thank you so much for sharing this tragic story! It is so sad that you had to needlessly suffer from this wrong diagnosis.

      Unfortunately, I have seen many younger people, especially women, misdiagnosed like this. This is why anyone with troubling palpitations or rapid heart beat should at least be offered a heart monitor by their physician.

      Best,

      John

  4. Our daughter is 40. Been on Atavin for 10 plus years. The pass 4 months really having anxiety and panic attacks. Her heart for 2 months or more is racing. Weeks stay 107-117. Might drop to 90 but right back up. Her BP is running a little low. They’ve been trying different meds to help her calm down. Everything flipps on her. They haven’t or won’t test to see why her heart stays racing 24/7. They say it’s your anxiety. We all know this isn’t safe to have her heart going like this. How can we help her, pleasd? Some days she’s so worn out even to stand

    • Hi Betty,

      A persistently rapid heart rate could be a sustained arrhythmia, the normal heart beat going fast due to a problem elsewhere in the body, or an inappropriate sinus tachycardia which is a fast heart beat from malfunction of the autonomic nervous system.

      This is something that should be evaluated immediately and cannot be diagnosed over the internet.

      Hope this helps!

      John

      • Thank you Dr!!!!! No it hasn’t happened again in over a year in a half. When I get anxious or wake up from sleeping I check the alive core always comes back sinus tachycardia thank god… any thoughts on buspar??? I’d like to try it but I’m scared. I take a half of Xanax .25 and I cut that in half when needed….. works well

        • Hi Barbara,

          With any medications, you always have to weigh the risks versus possible benefits. Only your doctor can help you with this analysis. If the benefits outweigh the risks for your situation, then it would be worth trying.

          Best,

          John