Is it a panic attack or a heart attack? How to tell them apart?
Psychiatrists advise how to make the distinction between the two and how to cope
I’ve found that music plays in my mind in the oddest of situations, like when I was waiting for my husband to be discharged from the hospital Emergency Room.
Earlier that day, my 34-year-old husband, called me from work and in what sounded like Morse, he said, “ …ambulance … going to hospital … chest pain … heart attack.”
A shiver ran down my spine and I could feel my t-shirt clinging to my back when I heard the last two words. One minute I was exchanging pleasantries with my colleagues, while heating my lunch, the next moment, I was trembling like a sopping wet child made to stand outside a pool as punishment from the coach.
My mind was screaming, “He’s going to die… he’s going to die… I’m going to die!” I was trembling, I did not know why. All I knew that those last two words had awakened me into a dreadful reality.
After five or so minutes that felt like eons, the fear and chills gave way and some kind of “normal” returned. I tried to steady myself enough to drive to the hospital where I was supposed to meet my husband. Like most people, I assumed, this episode might have been a panic attack, however, after speaking to psychiatrists for the sake of this story, I realised that those few minutes in hell, may not have been one.
Is it a panic attack or anxiety?
The fact that it comes out of the blue is the worst thing about panic disorders
Dr C B Binu, child and adult psychiatrist at Al Fasht Medical Centre, Sharjah, says that this dreadful feeling of “going to die!” along with chills, breathlessness, trembling and feeling frozen, are all symptoms of a panic attack, especially when it happens suddenly.
The fact that it comes “out of the blue” is the worst thing about panic disorders, he says. People might even be in a calm state of mind before a panic attack. Okay.
Then when is it not a panic attack?
If there is an event that triggers a fearful response, for example, when you see a wild animal, or when you see a car about to crash, you might feel panicky and anxious, but this is not a panic attack as there’s a clear reason why you’re feeling dreadful.
If there is an event that triggers a fearful response, for example, when you see a wild animal, or when you see a car about to crash, you might feel panicky and anxious, but this is not a panic attack as there’s a clear reason why you’re feeling dreadful.
What if it’s a heart attack?
A panic attack “…feels like a heart attack,” says Dr Binu. Someone suffering from a panic attack may even feel like their chest is tightening up. “During a panic attack, you’re not prepared for the episode of sudden panic, which sometimes increases the heart rate,” Dr Binu explains.
“People who have had a panic attack also complain of having palpitations and a pounding heart and since they feel like they’re going to die, or that everything is going to end, they rush to the hospital’s Emergency Room, thinking that they’re having a heart attack. We always explain that if there is nothing to prove anything is wrong with your heart or your lungs then it could be a panic attack.”
One reason why a panic attack feels like a heart attack is that a panic disorder is a neurochemical change in the right amygdala, located in the temporal lobe of the brain that controls your emotions connected to fear.
Remember the flight or fight response?
These neurochemical changes may increase palpitations and make you feel like you’re are having a heart attack. “Sometimes we want to see if there is anything related to the heart, if the patient suffers from any heart-related conditions like, for example, mitral valve prolapse. In this case we do an ECG to rule out any heart issues, especially if we suspect any family history with cardiac diseases.”
Information courtesy: www.nhs.uk
Why do we get panic attacks?
Like all anxiety disorders, panic attacks have a genetic vulnerability and it can come in any age group. You can have panic disorder from a very early age, and it is seen in children aged ten and above, according to Dr Binu.
Some people may be more vulnerable to panic disorders because of hormonal changes, bereavement or if they suffer from psychiatric disorders like anxiety or depression. Consuming flavour enhancers like Monosodium glutamate (MSG), caffeine, alcohol, or even smoking can trigger panic attacks especially amongst those who are vulnerable to it.
In the case of teenagers, Dr Binu says that doctors always try to learn more about the patient’s environment, if there are any domestic problems like violence, parental conflicts, or if there’s any family history with psychiatric disorders.
Checking for substance abuse like the use of alcohol or any neuro-stimulant drugs is another area that is important while diagnosing panic attacks in adolescents, especially for those in their late teens or early adulthood.
A surge in panic attacks post-COVID-19
Dr Waleed Ahmed, consultant psychiatrist from the Priory Wellbeing Centre in Abu Dhabi, has particularly witnessed an increase in panic attack cases among children and adolescents, recently. He also noted “... an increase in the presentation of anxiety disorders in otherwise well or low-risk people.”
Young people have definitely felt the full force of pandemic-related restrictions, such as limited social and physical interaction, excessive digital consumption and, of course, online schooling. For many, this has had an immense impact on their mental health, particularly in relation to anxiety and stress levels
The pandemic takes the blame for most of our problems these days including panic attacks. “We have seen a rise in (panic attack) cases, both during and after the pandemic, especially among children and adolescents. There is a common thread among the majority of patients – they were fine until the pandemic started and schools went online.
Young people have definitely felt the full force of pandemic-related restrictions, such as limited social and physical interaction, excessive digital consumption and, of course, online schooling. For many, this has had an immense impact on their mental health, particularly in relation to anxiety and stress levels,” says Dr Waleed.
What to look out for
According to Priory Wellbeing Centre, approximately one in four people will have a panic attack at some point and two per cent of those will go on to develop a panic disorder. Women are two to three times more likely to experience panic attacks than men, and the highest incidence of panic disorder is between 15 and 24 years, with a second peak later in life between 45 and 55 years.
There are symptoms to look out for, says Dr Waleed.
Intense psychological and physical symptoms are common with panic attacks
- including a strong feeling of dread, danger, foreboding, losing control, or dying
- feeling like one is not connected to the body or feelings of unreality
- ringing in the ears and abdominal symptoms like the need to go to the toilet
- breathlessness and feelings of choking
- racing or pounding heartbeat
- feeling sick, faint or dizzy
- chest pain
- sweating
- trembling
- numbness
- pins and needles sensation in fingers
“Panic attacks are harmless and do not physically cause damage. Patients with panic attacks usually do not require hospital admission. However, they can be quite debilitating if people start avoiding situations that they think are associated with the attacks,” he explains.
According to Dr Binu, people those diagnosed with a panic disorder are advised to undergo Anti-Panic Cognitive Behavioural Therapy (CBT) and relaxation techniques like JPMR - Jacobson's relaxation technique that focuses on tightening and relaxing specific muscles.
Anti-depressants are a common form of treatment as these medicines reduce the feeling of panic, immediately.
How to cope with panic attacks
Dr Waleed says that if you know what to expect, there are things you can do to help make further attacks easier to manage. During a panic attack, he advises:
- Recognise that this is a panic attack; it’s temporary and will soon pass; it is not life threatening. To realise this effectively, some familiarity may be required and so this is for subsequent panic attacks.
- Don’t try to avoid the situation – try and ‘stay with the feeling’ without fighting it
- Some people find it helpful to find an object to focus on and notice everything possible about it – they will verbally describe it in detail to themselves as a means of distraction and grounding
- Our thoughts, feelings, and bodily responses are interconnected, so think about a happy place, memory or positive experience
- Another grounding technique is to look at your surroundings and think about five things you can see, four things you can touch, three things you can hear, two things you can smell, and one thing you can taste
In terms of lifestyle changes, Dr Waleed adds: “Anything that reduces stress and anxiety levels can potentially limit the occurrence of panic attacks.
Effectively managing stress by taking breaks, managing time and tasks, getting enough sleep, eating wholesome foods, regular exercise, mindfulness practice, self-soothing activities like taking a massage and journaling all go a long way to help calm the mind and body. Reducing one’s caffeine intake will also help.”
“I can never really tell what might trigger my panic attack,” says Nayara Noor, a Sharjah-based customer service advisor. “Panic attacks come and go as they please and after having consulted a cardiologist and physicians, I’ve made peace with my heart attack like episodes.
When I have a panic attack I try to distract myself by talking to others around me and I force myself to focus on these conversations. Sometimes it helps, sometimes it doesn’t and it takes effort.
“When I have a panic attack I try to distract myself by talking to others around me and I force myself to focus on these conversations. Sometimes it helps, sometimes it doesn’t and it takes effort. It’s important that we mustn’t lose heart and know that it will eventually go away.”
Coming back to my husband, since his vitals were all normal, the ER doctor said he too might have had a panic attack. However, in my case, as the symptoms were brought on by real fear, it wasn’t a panic attack, but extreme anxiety. It is extremely essential to know to difference, to cope better.