The irregular heartbeat known as atrial fibrillation (afib), a physical disorder, shares some symptoms with a panic attack, an emotional problem, said John Day, MD, director of Heart Rhythm Services at Intermountain Medical Center in Salt Lake City. Pounding in your chest, difficulty breathing, chest pain or discomfort, and feeling dizzy or lightheaded are panic attack symptoms that overlap with afib symptoms. Sudden onset is another. “Either could start at any time for any reason,” Dr. Day said, about afib and panic attack. However, not all symptoms are the same, and the differences can help your doctors determine what’s causing your heart to race.
Afib or Panic Attack?
A single panic attack can last a few minutes or an hour. A type of arrhythmia called supraventricular tachycardia (SVT) can make your heart beat as much as 150 to 250 times a minute. This is the heart arrhythmia most likely to be mistaken for a panic attack. An episode of SVT can last 5 seconds or until your doctor does something to stop it, Day said, “so length of time doesn’t really distinguish between the two.” One difference with afib though, is that the irregular heartbeat symptoms start and stop suddenly. With a panic attack, your heart rate slowly returns to normal. Another difference is that your heartbeat in atrial fibrillation is totally erratic. “You could have two or three beats super fast, and two or three slower, and two or three fast — your heart rate is bouncing all around,” Day said. “With a panic attack, your heart is going fast, but it’s totally regular.” Stephen Sobel, MD, a San Diego psychiatrist who treats anxiety disorders and is the author of “Successful Psychopharmacology: Evidence-Based Treatment Solutions for Achieving Remission” said that people having a panic attack feel panic. They have a sense that the world doesn’t seem real, or a fear that they’re going crazy. “Generally, people with a heart arrhythmia don’t have this emotional component,” he said.
Medical History Provides Clues
Your medical history may offer hints as to whether you’re experiencing a panic attack or afib. Often panic attacks are precipitated by some anxiety or depression or another psychiatric difficulty. Also, whether you’ve had a panic attack in the past could be a clue. Dr. Sobel said “the presence of one panic attack increases the likelihood of another.” Likewise, he said, a family history of cardiac disease and arrhythmias may point in a different direction. Women may have atypical symptoms of a heart attack or other heart condition, such as a burning sensation in the upper abdomen, an upset stomach, or sweating. Doctors don’t always consider a heart attack or heart arrhythmia when women come to the ER with those symptoms, said Michelle B. Riba, MD, a professor and associate chair for integrated medical and psychiatric services at the University of Michigan.
Age Matters
Age can also be a factor. Younger women are more likely to have tachycardia, the heart condition that’s sometimes mistaken for a panic attack. “The reason is that SVT (tachycardia) often manifests at a younger age, in your teenage years or 20s or 30s, and is more common in women,” Day said. But what happens, Day added, is that “they look at this young healthy woman and think she can’t be having a heart problem — it must be some sort of anxiety disorder.” Atrial fibrillation typically shows up later in life, when people are in their 50s, 60s, and 70s, Day said.
See Your Doctor
If you’re having chest pain and aren’t sure whether it’s atrial fibrillation or panic attack, Dr. Riba stressed the importance of seeking immediate medical attention. As with any medical condition, it’s better to be safe than sorry. “It could be a panic or anxiety attack, and it’s not going to kill you if it is,” she said. “But if it’s an arrhythmia or another heart condition, you won’t know until you are tested and get a good medical history.” If doctors suspect a heart arrhythmia, they’ll order an electrocardiogram (EKG) or ask you to wear a Holter monitor for 24 hours or longer to record your heart rhythm. A panic disorder may be diagnosed after the other medical conditions are ruled out, Riba said.
