How To Tell The Difference Between Anxiety Chest Pain And Cardiac Chest Pain
There’s no guaranteed method of knowing whether or not chest pain is caused by anxiety or by a heart problem. But generally the two differ in their overall experience:
Anxiety Chest Pain
- Is usually more localized to a specific area.
- Closer to the middle of the chest, although not necessarily.
Cardiac Chest Pain
- Tends to radiate all around the shoulder and possibly the jaw.
- Tends to be a duller pain, like the heart is being crushed.
- Lasts longer than 10 minutes or more.
There are a lot of similarities between the two. Both may have lightheadedness or dizziness and feel like the heart is being squeezed. Both can make it harder to breathe . It’s not easy to tell the difference, but the differences are there. Furthermore, once you identify what anxiety chest pain feels like for you, in the moment, you may feel more reassured about what your symptoms are indicating .
Diagnosis Of Anxiety And Heart Disease
Diagnosing anxiety disorders in people with cardiovascular disease is difficult because there is a substantial overlap between the symptoms of anxiety disorders and those of heart disease.
Accurate diagnosis is necessary for the proper treatment of these disorders. Your primary care physician can diagnose anxiety disorders and heart diseases but may refer you to a mental health professional and cardiologist for treatment.
Some tests that your doctor may perform to diagnose heart disease include:
Mental health conditions like anxiety disorders are diagnosed using the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition . The DSM-5 criteria for an anxiety disorder include:
- Excessive anxiety and worry that occurs more often than not for at least six months
- Difficulty controlling levels of worry
- Feelings of anxiety that are accompanied by at least three of six total symptoms, including restlessness or feeling on edge, fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbances
- Physical and psychological symptoms cause significant issues with daily functioning
- Anxiety is not caused by drug abuse, medication, or another condition
Panic Attack Or Heart Attack
The symptoms of a panic attack can overlap the symptoms of a heart attack, clinically termed myocardial infarction , making it difficult for a person to know which one may be occurring.6 People often go to the emergency room with chest pain believing they have a heart issue, but research shows that roughly 60% to 90% of ER patients with chest pain do not have a cardiac cause of the pain.7
How does a panic attack feel different from a heart attack?
Unfortunately, says Una McCann, MD, professor of psychiatry and director of the Anxiety Disorders Program at Johns Hopkins School of Medicine, They can feel identical. People often are short of breath, feel dizzy, and can feel crushing chest pain. Somebody who is perfectly healthy, with great lungs, undergoing a panic attack can feel really, really short of breath. And then, of course, those symptoms feed on the panic so it builds exponentially to this enormous crescendo.
Dr. McCann explains that because of the many different ways that people experience symptoms of heart attacks and panic attacks, theres no way to know the cause of those symptoms on your own.
There are a variety of symptoms that people who are having myocardial infarctions experience or dont experience, so certainly if someone came in with a panic attack to an emergency room, they would undergo a full workup for an MI, no question, she says.
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What Are The Symptoms
Symptoms of stress cardiomyopathy include sudden onset of chest pain, sweating, nausea, vomiting, shortness of breath, low blood pressure, and abnormal heart rhythms. These symptoms normally occur soon after a severely stressful event. Because many of these symptoms are also symptoms of a heart attack, it is easy to mistake stress cardiomyopathy for a heart attack.
Stress cardiomyopathy vs. heart attack Heart attacks and stress cardiomyopathy can have very similar symptoms but they are different conditions. Most heart attacks are caused by blockages or blood clots in the coronary arteries , resulting in a decreased flow of blood to the heart that can lead to heart muscle cells to die. This is what can cause permanent damage to the heart muscle cells.
On the other hand, the heart is not permanently damaged with stress cardiomyopathy. Stress cardiomyopathy does not seem to be a result of artery blockages or blood clots. For most people that suffer stress cardiomyopathy, the heart weakness usually stops within a couple of weeks and there is no permanent damage.
Monitor Your Heart To Detect Anxiety Or Atrial Fibrillation
The best way to truly understand whether anxiety causes a fast heart rate, or if a fast heart rate causes anxiety, is to monitor your heart.
A heart monitor records your heart rhythm day and night. Some automatically record all heart rhythms others require you to push a button when you feel heart symptoms. When you dont have symptoms, heart monitors may not provide the information needed for a diagnosis. For that reason, I have patients use them for two to four weeks to increase my chances of capturing the event.
Over the past two years, more people are using their smartphones to keep track of their activity and heart rate, but each device has limitations. What’s important, however, is your daily trend.
Your heart rate varies throughout the day by a few beats per minute up to 10 bpm, even when doing very little activity or experiencing infrequent stress. When exercising, the variation may be more pronounced and change more quickly, which allows us to quickly adapt to different situations and challenges. When you look at the daily trend, you will quickly find your normal. This normal will have the lowest heart rates at night, and then change predictably during the day while at work and rest, and during exercise.
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Why Does Anxiety Cause Chest Pain
Anxiety is the bodys response to a real or perceived stressor, and anxiety and panic attacks can produce a number of physical symptoms in addition to mental turmoil.
When youre anxious, your body enters whats typically referred to as a fight or flight state, preparing to help you battle against something that could hurt you.
Your body does this in many ways, including increasing your heart rate, breathing rate, and blood pressure, and by triggering the release of adrenaline and noradrenaline.
Many of these fight or flight responses can cause chest pain. Common causes for chest pain include:
- Muscle tension: This is typically a result of stress and can manifest itself as tightness in the muscles in the chest.
- Increased heart rate: This can lead to feelings of pounding in the chest, heart palpitations, and coronary artery spasms.
- Hyperventilation: This is a result of shortness of breath, and can cause changes to the level of carbon dioxide in the blood.
- Increased blood pressure: This can increase oxygen demand in the heart and put a strain on the smaller blood vessels due to increased blood flow.
Diagnosis Of Anxiety Disorders
Diagnosing anxiety disorders in patients with cardiovascular disease is difficult given the substantial overlap between the symptoms of anxiety disorders and those of cardiovascular disease. Many symptoms of GAD, such as restlessness, fatigue, poor concentration, and sleep disturbance, are very common in patients with cardiac disease, especially HF. Similarly, nearly all the symptoms of a panic attack could potentially be experienced in the setting of an arrhythmia, ACS, or paroxysmal nocturnal dyspnea. If one relies too heavily on these overlapping symptoms, there is a significant risk of attributing cardiac symptoms to anxiety.
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Mechanisms Mediating The Relationships Between Anxiety Disorders And Cardiac Health
There are several mechanisms that may explain the underlying association between anxiety disorders and cardiac disease. Though no definitive model exists, these hypotheses include both behavioral and physiologic factors .
Potential mechanisms mediating the relationships between anxiety disorders and cardiac health
Can Anxiety Cause Chest Pain
Yes. Many people who experience anxiety also experience chest pain, especially during anxiety or panic attacks.
Though it can be frightening and painful, anxiety sufferers can take some comfort in knowing that theres a reason for this uncomfortable symptom: Its your brain and body trying to protect you from a real or perceived stressor.
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Can Anxiety Cause A Heart Attack
Many studies have linked heart disease and depression, but heart problems may also go hand in hand with anxiety.
Several studies have shown that about a quarter of people with cardiovascular disease have some kind of anxiety problem and, in some cases, the anxiety seems to make the heart condition worse.
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How To Tell The Difference Between A Heart Attack And A Panic Attack
The best way to tell the difference is to simply visit the doctor and have your heart tested. If your heart is in good health, it’s very unlikely you are suffering from a heart attack, especially if you have signs of anxiety. The good news is that there are plenty of easy tests to rule out any serious heart problems.
Beyond that, there are very minute differences in the symptoms. Examples include:
- Chest pain from anxiety tends to be more localized and sharp, while heart attacks radiate and are often duller.
- Panic attacks rarely cause vomiting – a somewhat common symptom of heart attacks, although not in all of those that experience one.
- Panic attacks tend to be more systematic. They generally peak about 10 minutes in and then there is a slow and steady decline. Heart attacks can follow this same pattern, but it’s less common.
Otherwise, the best thing to do is get your heart checked and learn whether or not you’re suffering from any heart problems. If not, then you’re experiencing anxiety attacks.
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Stress Can Cause A Cardiac Event That Resembles A Heart Attack
More than 90% of stress-induced cardiomyopathy cases occur in older women.
- Sudden stress can cause a cardiac event that feels like a heart attack, called takotsubo cardiomyopathy or broken heart syndrome.
- This stress-induced cardiomyopathy isnt associated with the artery blockages that lead to a heart attack, though it may cause your heart to pump inefficiently for up to a month.
- Chronic stress can also cause high blood pressure and lead to smoking or an unhealthy diet, which are major risk factors for a heart attack.
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While stress cant directly cause a heart attack, it can have a major impact on your heart health, and even trigger an event that feels just like a heart attack.
Heres what you need to know about stress-induced cardiomyopathy, as well as the effects of chronic stress on your heart and how to manage it.
Why Do People With Heart Conditions Feel Anxious
Many people worry about the future when theyve just been diagnosed with a heart condition. Its common to feel anxious after a life changing heart attack or surgery or when having symptoms such as chest pain. Anxiety about whether a device like a pacemaker or ICD will not work properly is also very common.
Feeling anxious, worried or fearful is a natural response to life changing experiences. For most people the fear and anxiety eases off as they come to terms with their condition and learn how to manage it.
But its important to recognise when these feelings carry on for longer than usual and start affecting your health, relationships and quality of life.
Take Stock Of The Situation
Accept your feelings of anxiety, recognize them, and then work through putting them in perspective.
Are you worried about something you cant control? Are you fearful of an outcome thats unlikely? Are you dreading a situation you cant control the outcome of? Talk your way through your feelings to find the source, and then work to put them into perspective.
The Truth Behind Anxiety Disorders
Anxiety is a normal reaction to stress that can often prompt us to be more cautious and keep us out of danger. While anxiety, stress, and nervousness can be a normal part of life, chronic and persistent anxiety that begins to affect normal daily functions is defined as a mental illness, known as anxiety disorder. Anxiety disorder is a chronic condition characterized by disproportionate and persistent anxiety. The five major types include generalized anxiety disorder, obsessive-compulsive disorder , panic disorder, post-traumatic stress disorder and social anxiety disorder.
While there have been multiple studies that link depressionto heart disease, the relationship between anxiety and cardiovascular disease seemsto be a little more complex. Due to the high prevalence of anxiety in cardiovascular patients,researchers are further investigating if anxiety is a direct cause of heartdisease or simply a correlation.
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Panic Attack Vs Heart Attack: How To Tell The Difference
Your heart suddenly begins racing. You feel pain in your chest and you are short of breath.
Are you having a heart attack? Or could it be a panic attack?
Although they share a number of similarities, the two conditions result from very different disease processes. Panic attacks arise when stress hormones trigger the body’s “fight or flight” response, often resulting in racing heart, chest pain and shortness of breath.
In the case of a heart attack, a blockage in a coronary artery may result in the same symptoms. “Chest pain, rapid heartbeat and breathlessness may result when an insufficient amount of blood reaches the heart muscle,” says Tung.
One of the key distinctions between the two is that a heart attack often develops during physical exertion, whereas a panic attack can occur at rest.
A heart attack is more likely to develop when the work load of the heart increases, for example while a person is shoveling snow or running up the stairs, especially in people who do not routinely engage in physical exertion.
Another difference is duration: Panic attacks tend to gradually subside and resolve on their own within about 20 minutes. A heart attack, however, will often continue and may worsen over time.
When Your Heart Skips a Beat
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Read our Heart Matters article to find out more about the difference between a heart attack and a panic attack.
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