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Is Your Chest Pain a Heart Attack or Anxiety?

When you experience a painful sensation near your heart, it's natural to have chest pain anxiety and worry about what it might be. Here are some key things to know.

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Heart attack vs. anxiety

Every 40 seconds, someone in the United States has a heart attack, according to the Centers for Disease Control and Prevention (CDC). But panic attacks or panic disorder strike 2.7 percent of the population each year, according to the National Institute of Mental Health, and they can also produce chest pain anxiety.

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Chest pain isn’t limited to heart attacks

According to the CDC, of the 790,000 Americans who have heart attacks each year, 580,000 are a first heart attack. If you feel tightness, squeezing, pain, or an ache in your chest that spreads into the arms or jaw, then head to the nearest ER. According to the MayoClinic, these are classic symptoms of a heart attack.

But panic attacks can also trigger chest pain anxiety—sometimes sharp pain coupled with erratic, rapid heartbeats—and sometimes the pain may spread. “Part of the problem is that a lot of the hallmarks of a panic attack are exactly the same as a heart attack,” says Knox Todd, MD, former Professor and Chair of Emergency Medicine at MD Anderson Cancer Center, and a practicing emergency physician for over 40 years. There are other reasons you might have scary chest pain.

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Symptoms of anxiety and heart attack are similar

It’s almost eerie how anxiety and heart attacks can mimic each other:

Key warning signs of a heart attack, according to the American Heart Association:

  • Chest discomfort that comes and goes or stays
  • Discomfort in other areas of the upper body
  • Shortness of breath
  • Nausea
  • Sweating
  • Jaw pain—which is slightly more prevalent in women

Some key symptoms of a panic attack, according to the Anxiety and Depression Association of America:

  • Sense of impending doom or danger
  • Rapid, pounding heart rate
  • Sweating
  • Nausea
  • Chest pain
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Timing in anxiety vs. heart attacks

Though some heart attacks hit without warning, there can be early signs; some symptoms include radiating chest pain and queasiness that come and go over a course of hours, weeks, or months. Panic attacks, though, are more like rogue lightning strikes that only last for ten to 30 minutes. “It may come out of the blue and suddenly a person is gripped by very intense symptoms—such as I can’t breathe, I feel as though my throat is constricting, my heart is racing, my palms are sweating,” says Dr. Todd. “All the adrenaline in the body that comes with a panic attack creates a large variety of symptoms. It’s quite an event.” Here are more signs you may be having a panic attack

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Consider your risk and history

The risk of a heart attack rises as people reach middle age. It’s less likely to be heart disease if you’re a young, healthy person, says Dr. Todd. “Healthy people in their 20s very rarely have heart or cardiovascular problems or blood vessel problems.” But it can happen: Here’s the story of one woman who had a heart attack at 21.

Do you have a history of panic attacks? “If you’ve had them before, you’ve been evaluated, and doctors have assured you that this is more consistent with panic attacks,” says Dr. Todd, “then it’s more likely to be a recurrent panic attack. But not always.”

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What happens with chest pain in the ER?

If you’re having chest pain anxiety and aren’t sure why, get yourself checked right away. “In an emergency department we always ask, ‘Well, what’s the worst this thing could be?'” says Dr. Todd, “and we think about that possibility and then attempt to rule that out even if the likelihood is very small.” To do that, they will do an electrocardiogram (EKG) to evaluate the heart, and then possibly blood tests, and you’ll usually be held for further observation. Here’s a step-by-step guide if you suspect you or a loved one is having a heart attack.

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Treatment when it’s a panic attack

If it’s likely your chest pain anxiety is from a panic attack, you might be given medication, talk therapy, or relaxation exercises. Your caregivers will recommend a follow-up appointment with the appropriate doctor—both to help prevent future attacks and to more decisively rule out any heart issues. “If we arrive at the diagnosis of a panic attack, it’s always with some caution,” Dr. Todd says. “Seeing someone once in the emergency department doesn’t give all the information you need to make that decision.” Know these four ways to calm down from a panic attack.

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Dealing with a heart attack

If an EKG and/or blood tests reveal that your chest pain is not anxiety, but because blood flow to your heart is compromised—a heart attack—you’ll be treated right away based on your tests and risk factors. “We move into rapid mode,” says Dr. Todd. “The decision-making is complex but rapid.” You might be taken to a catheterization lab where dye is injected into the heart to examine it. “We will use mechanical or chemical means to get rid of the clot,” says Dr. Todd, “thereby preserving heart muscle.” Here are some essential things survivors did after a heart attack.

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Follow-up for panic attacks

If your chest pain was indeed related to anxiety and a panic attack, you’ll be sent to your own or another doctor for treatment. “Panic attacks are scary things,” says Dr. Todd. “To trivialize a panic attack by saying, ‘Oh, it’s not going to kill you,’—that’s someone who doesn’t understand how serious those symptoms really are.” You may be given breathing exercises, a therapy regimen, and ways to identify and manage the situation that led to the attack. According to the Mayo Clinic, many people only have one or two panic attacks in a lifetime, others have them reoccur. You can try these 11 tips for managing anxiety and panic disorder.

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What happens after a heart attack?

Once the acute situation of a heart attack has been resolved, the American Heart Association recommends staying on top of your medications and putting your energy into preventing a second heart attack. Address whatever controllable risk factors may have caused your heart attack—being inactive, obesity, smoking, poor diet. Your cardiologist will have good advice, and you can also get support through cardiac rehab and cardiac support networks. Make sure you take these steps right after a heart attack scare also.

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