A man in his fifties clutches his chest and collapses. This classic heart attack presentation may be common in the movies, but in real life the signs are not always as obvious. They are also commonly confused with panic attacks.

And understandably so. There are many similarities between the symptoms of a heart attack and a panic attack, explains Randy Cohen, MD, a cardiologist at Summit Health. “The overlap can make it difficult to tease out the symptoms,” he says. “When in doubt, or if you are having pain lasting more than 15 minutes or so, it is probably worth going to get evaluated at an urgent care or hospital.”

Signs and Symptoms of a Heart Attack vs. Panic Attack

Both heart attacks and panic attacks are unfortunately very common—and very real. Every 43 seconds someone in the U.S. has a heart attack. Panic attacks affect at least 1 in every 10 adults each year, though physicians say they have been on the rise throughout the pandemic.

To begin to understand the difference between heart and panic attacks, imagine these two general scenarios.

Patient one is a middle-aged man who is overweight. While he is shoveling snow, a squeezing pain develops on the left side of his chest. As he walks inside, the man has trouble catching his breath. The feeling does not get any better when he sits down. In fact, the man starts to feel nauseous and is sweating through his shirt. These are classic symptoms of a heart attack.

Signs of a heart attack include:

• A feeling of pain, pressure, or squeezing in the chest
• Discomfort or pain in the arm, back, neck, or jaw
• Shortness of breath
• Nausea or vomiting
• Lightheadedness
• Breaking out in a cold sweat

Patient two is a young woman who is on a tight deadline at work. She begins to feel as though her heart is beating out of her chest. As she walks over to the couch she becomes short of breath. Her palms are sweating and there is a tingling sensation in her hands. After she sits down for 20 minutes the woman starts to feel better. These are common signs of a panic attack.

Symptoms of a panic attack include:

• Racing heartbeat
• Feeling weak or dizzy
• Difficulty breathing or hyperventilating
• Tingling or numbness in the hands
• Sweating or chills
• Sense of impending doom

Clues to Tell the Difference

Here are a few tips that can help you differentiate between a heart and panic attack.

1. Provocation - What triggered the attack? A heart attack is more likely to occur when there is a higher workload placed on the heart. This typically happens during some type of physical exertion, such as shoveling snow or working out at the gym. In comparison, a panic attack is more common when you are resting, sitting down, or even in the middle of the night.

“The best separator for people is usually the idea that heart attacks tend to be associated with physical exertion. A panic attack is an emotional response to something that is making you feel anxious. It is not related to a physical situation where you have overexerted yourself,” says Patrick O’Hara, LCSW, a behavioral therapist who has been counseling adults about panic attacks for nearly twenty years.

2. Duration - How long does the feeling last? If you are experiencing a heart attack, the chest pain and shortness of breath will typically get worse. The symptoms of a panic attack, however, usually subside after about 20 minutes.

3. General vs. Local Pain - Can you pinpoint the exact area of discomfort and where it radiates? In a panic attack, individuals usually describe generalized tightness across the entire chest while a heart attack is more localized. The pain also tends to radiate from the chest to other areas including the neck, jaw, or left arm during a heart attack.

“In general, people experiencing a panic attack describe more of a vague sense of impending doom that is then accompanied by a variety of symptoms. With heart attacks, the symptoms tend to be more localized and specific,” explains Dr. Cohen.

4. Medical history - Do you have risk factors? An individual without any red flags can certainly have a heart attack, but it is more likely to occur in patients who are overweight or have a history of cardiac problems, high blood pressure, or high cholesterol. Panic attacks are more common in individuals who are under a lot of stress at work or home, or those who suffer from anxiety and depression.

Women and Heart Attacks

For women, it can be even more difficult to differentiate because the symptoms of a heart attack are less obvious. As a result, explains Dr. Cohen, women are often undiagnosed.

Patient three is a 50-year-old woman in fairly good health. She has been feeling unusually tired this past week. While walking the dog, she begins to feel lightheaded and nauseous. She notices a nagging feeling in her upper abdomen and thinks she must be coming down with something.

Women typically do not experience chest pressure when they have a heart attack. Instead, symptoms often include:

• Shortness of breath
• Fatigue
• Lightheadedness or fainting
• Pressure or pain in the lower chest, upper abdomen, back, or jaw.

How the Experts Can Help

Even though a heart attack is medical in nature and a panic attack is behavioral, both problems are serious and cause the body to have physical responses.

During a heart attack, blood flow to the heart is either reduced or interrupted entirely. In a panic attack, the body’s fight or flight response kicks into high gear and adrenaline surges.

“The sense of impending doom—this feeling like you are going to die—is quite real during a panic attack,” explains O’Hara. “This is what leads people with panic attacks to visit the emergency room several times before they come to behavioral health because they are convinced each time that something is medically very wrong with them.”

With rates of anxiety and depression on the rise, panic attacks have become increasingly common throughout the pandemic. O’Hara advises patients that they can learn to have control over their panic attacks.

“Education is everything,” O’Hara says. “Behavioral health clinicians are here to teach you the tools you need to both prevent and manage panic attacks.”

Dr. Cohen and his colleagues on Summit Health’s cardiology team are also here to help. He says patients sometimes feel embarrassed when they come in with symptoms and everything checks out.

“I try to communicate to them how important it is to listen to their body and that they did the right thing by coming in for a medical evaluation,” says Dr. Cohen. “At Summit Health, that is what we are all here for – to check people out and listen to their concerns.”

Ignoring heart attack symptoms can be fatal. If you are uncertain your symptoms are a sign of a heart attack, seek immediate medical attention.