Distinguishing Between Panic Attacks and Heart Disease Symptoms

Panic and heart disease?

Hello, Doctor.
I would like to ask how to differentiate between a panic attack and a heart problem.
A couple of days ago, I accidentally experienced an episode while sleeping; I wasn't sure if it was due to being too hot and sweating or night sweats that startled me.
My heart rate increased to 140-160 beats per minute and lasted for about a minute, so I quickly went to the emergency room.
How can I distinguish between panic anxiety and a heart issue?
Additionally, I would like to ask if sometimes when I lie down or sit up, I feel my heart beating harder and experience a bit of shortness of breath when I stand up.
Is this related to anxiety? If both the electrocardiogram and echocardiogram are normal, does that mean it is anxiety-related? Should I not worry about the sensation of shortness of breath and the stronger heartbeat when standing up, or could it be due to a lack of exercise? This situation has made me hesitant to exercise.
Do you have any suggestions? Thank you, and take care.

Niming, 20~29 year old female. Ask Date: 2023/07/09

Dr. He Dongjin reply Cardiology

Hello, you do not have heart disease.
Your current symptoms are mostly caused by panic and anxiety.
Both the electrocardiogram and ultrasound are normal.
A heart rate of 140-160 beats per minute can be a normal response when you are frightened.
You are too anxious; try to relax.
Everything is fine.
We pray for your peace.
Changhua Hospital cares about you.

Reply Date: 2023/07/09

More Info

Distinguishing between panic attacks and symptoms of heart disease can be challenging, especially since both conditions can present with similar symptoms such as rapid heart rate, shortness of breath, and chest discomfort. It is essential to understand the differences and the underlying mechanisms of each condition to make an informed assessment.

Panic attacks are characterized by sudden episodes of intense fear or discomfort that peak within minutes. Symptoms often include palpitations, sweating, trembling, shortness of breath, feelings of choking, chest pain, nausea, dizziness, chills, or hot flashes, and a fear of losing control or dying. These symptoms can occur without any apparent trigger or may be associated with stressful situations. Panic attacks are often linked to anxiety disorders and can be exacerbated by stress, caffeine, or certain medications.

On the other hand, symptoms of heart disease, such as angina or myocardial ischemia, may also present with chest pain or discomfort, shortness of breath, and palpitations. However, these symptoms are typically related to physical exertion or emotional stress and may be accompanied by other signs like nausea, sweating, or lightheadedness. Heart disease symptoms can be more persistent and may not resolve quickly, unlike panic attacks, which usually subside within a short period.

In your case, experiencing a rapid heart rate of 140-160 beats per minute upon waking, along with feelings of sweating and anxiety, could suggest a panic attack, especially if it occurred suddenly and resolved quickly. However, it is crucial to consider your overall health, including any risk factors for heart disease, such as family history, lifestyle factors, and any previous medical conditions.

The fact that your electrocardiogram (ECG) and echocardiogram results are normal is reassuring. These tests help rule out significant structural heart disease or arrhythmias. However, if you continue to experience symptoms such as increased heart rate, shortness of breath, or chest discomfort, it is advisable to consult with a healthcare professional for further evaluation. They may recommend additional tests or a referral to a cardiologist or mental health specialist to address both potential cardiac and anxiety-related issues.

Regarding the sensation of a strong heartbeat and shortness of breath when standing up or changing positions, this could be related to several factors, including orthostatic hypotension (a drop in blood pressure upon standing), anxiety, or even deconditioning due to a lack of physical activity. It is essential to maintain a regular exercise routine to improve cardiovascular fitness and overall well-being. Gradually increasing your activity level can help your body adapt to physical exertion and reduce anxiety symptoms.

In summary, while panic attacks and heart disease can share similar symptoms, understanding the context and accompanying signs can help differentiate between the two. Given your normal cardiac evaluations, it is likely that your symptoms may be more related to anxiety. However, ongoing symptoms warrant further discussion with your healthcare provider to ensure a comprehensive approach to your health. Consider lifestyle modifications, such as regular exercise, stress management techniques, and possibly consulting a mental health professional to address anxiety.

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