Is it anxiety, or something wrong with my heart?

A pounding heart, a tight chest, breathlessness, tingling in the hands, a feeling that something terrible is about to happen. These are some of the most frightening sensations a person can have, and they are shared by two very different things: a panic attack and a heart problem.

Many people with panic attacks first go to an emergency department sure they are having a heart attack. That is not an overreaction. Chest symptoms should be taken seriously until a heart cause has been ruled out.

Get emergency help now (call 112 or go to the nearest emergency department) if you have chest pain or pressure that spreads to the arm, jaw, neck or back; chest pain with sweating, nausea or fainting; chest pain that comes on with exertion; or if you have diabetes, high blood pressure, a smoking habit or a family history of early heart disease and new chest symptoms. Don't wait to work out whether it is anxiety.

What a panic attack is like

A panic attack is a sudden surge of intense fear with strong physical symptoms. It usually builds to a peak within about ten minutes and then eases, often leaving you exhausted. Common features include:

• A racing or pounding heart
• Shortness of breath or a feeling of choking
• Tingling or numbness in the hands, feet or around the mouth
• Sweating, trembling, feeling hot or cold
• Dizziness or feeling faint
• A sense of unreality, or of losing control
• A strong fear of dying or "going mad"

Panic attacks can come out of the blue, including at rest or even waking you from sleep. Afterwards, many people start avoiding places where an attack happened, or worry constantly about the next one. That fear of the next attack is often what keeps the cycle going.

Clues that point towards anxiety

• Your heart has already been checked (for example with an ECG and examination) and found healthy
• The symptoms come with waves of fear or dread, and settle within minutes
• They happen at rest as often as on exertion
• Breathing fast makes the tingling and dizziness worse
• You have had similar episodes before, with normal tests

None of these on their own rules out a heart problem. They are reasons to suspect anxiety once a doctor has checked your heart, not a substitute for that check.

If your heart is fine, what next?

Being told "it's just anxiety" can feel dismissive, but panic disorder is a real and very treatable condition. Treatment usually combines:

• Understanding what is happening in the body during an attack, which takes away much of its power
• Talking treatment, especially cognitive behavioural therapy (CBT), which has strong evidence for panic
• Gradually returning to places and activities you have started to avoid
• Looking at sleep, caffeine, alcohol and stress, which all make attacks more likely
• Medication, when attacks are frequent or very disabling, chosen and reviewed with your doctor

Some calming tablets work quickly but can become habit-forming if taken regularly, so they are best used sparingly and only under medical advice.

When to see a psychiatrist

It is worth seeing someone if attacks keep returning, if you have started avoiding work, travel or crowded places, or if worry about the next attack is shaping your days. Many people manage this with a few consultations and a clear plan.

If you are having thoughts of harming yourself, please don't wait: call Tele-MANAS on 14416 (free, all day and night) or go to the nearest emergency department.

More on anxiety, panic and sleep problemsFind a time

Sources

• World Health Organization: Anxiety disorders (fact sheet)
• NHS: Panic disorder
• NHS: Chest pain

This article is general information, not a substitute for advice about your own situation.