Dr. John Day, Cardiologist

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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?