Why a panic attack can feel just like you're having a heart attack

Defined as a sudden surge of anxiety and fear, with severe physical reactions, a panic attack will be experienced by up to 35 per cent of the population at some point in their lives. Julie Cook finds out more

A panic attack is defined as a sudden surge of anxiety and fear, with severe physical reactions
A panic attack is defined as a sudden surge of anxiety and fear, with severe physical reactions

ON an otherwise uneventful day last December, Kerry Clayton was at home, working on her laptop, when she suddenly felt incredibly unwell.

"It hit me all at once — a clamminess, dizziness, a racing heart and palpitations, a pain up one arm and a tightness across my chest," recalls Kerry ( 33).

"I thought: 'I’m having a heart attack.'"

Her husband, David (34), an accountant, came in to the room, took one look at her and rushed Kerry to hospital.

"In A&E I had a triage assessment, then was whisked through to a bed where I was hooked up to machines," says Kerry, a mother of two, who runs her own sustainable jewellery business.

"I was lying there thinking: 'What if I die? What if I need heart surgery?'"

She was kept in for several hours and underwent an ECG (electrocardiogram, which monitors the electrical activity of the heart) and an echo-cardiogram (a type of scan of the heart).

Both came back clear, which ruled out a heart attack. Instead, Kerry was told she’d had a panic attack.

Defined as a sudden surge of anxiety and fear, with severe physical reactions, a panic attack will be experienced by up to 35 per cent of the population at some point in their lives, according to the charity Anxiety UK.

"Someone might report loss of control, a pounding heart, tightness of the chest, tingly fingers or weakness in their arms," explains Mike Ward, a psychotherapist who specialises in panic attacks at The London Anxiety Clinic.

"It can be frightening because they feel as though they’ve got no conscious control over that situation," he says, adding that he has seen an increase in panic attacks in recent years.

And, says Dr Simon Modi, a consultant cardiologist and electrophysiologist (heart rhythm specialist) at the Liverpool Heart and Chest Hospital, it’s not uncommon for people who experience a panic attack to be convinced they’re having a heart attack — although some heart problems are initially mistaken for panic attacks (more on this later).

"I commonly see patients with a crossover between heart conditions and panic attacks," he says.

Kerry was stunned by her diagnosis. "The symptoms were so real I couldn’t believe there wasn’t more to it," she says.

"I even asked: 'Can you run the tests again?' But they told me no — they were accurate."

She went home drained — and confused. "Of course, I was relieved I hadn’t had a heart attack, but I was still upset," she says. "I felt dismissed, as if I’d wasted everyone’s time, when to me it had felt so real.

"No-one advised me on what to do next or where to go for help."

Kerry feared it would happen again — a common worry, according to Mike Ward, who adds that fear of attacks recurring can lead to more panic, creating a vicious cycle. So it’s important that people get adequate support.

So what causes panic attacks — and why can they feel so much like a heart attack?

"To understand a heart attack, you need to understand what the heart is," says Dr Modi.

"It is a muscular pump that pushes blood around the body and through the lungs. And, like any muscle, it needs a blood supply — which comes from the coronary arteries.

"A heart attack is usually where the blood supply to a part of the heart is compromised. [Typically, when there is a blockage in an artery, such as fatty deposits or a blood clot.]

"Like any muscle, if the supply of blood doesn’t meet the need of the muscle, it will 'cramp up'," explains Dr Modi.

"The cramping causes a central chest pain or band-like tightness around the chest, often travelling down the left arm or into the jaw.

"This is called angina if there is reduced blood supply or, if it is completely blocked, a heart attack."

By contrast, he explains, "panic attacks are episodes where the body and mind suddenly develop a 'fight-or-flight' response".

When this occurs, it causes a sudden surge of adrenaline, a hormone that signals tissues around the body to prepare to deal with a potential threat by, for example, increasing blood pressure to get more blood to the heart and muscles so the body can run faster.

It’s normal for adrenaline to be released during exercise or in moments of stress.

However, a panic attack is an over-the-top version of this response, and it’s the sudden, overblown surge of adrenaline that causes symptoms that mimic a heart attack.

"The chest discomfort in panic can be due to spasm of the oesophagus (gullet), or spasm of the coronary arteries, due to a sudden mismatch in the blood supply to the heart after a sudden adrenaline-fuelled rise in heart rate," explains Dr Modi.

Unlike with a heart attack, where shortness of breath is down to low oxygen levels due to inadequate blood supply, with a panic attack, shortness of breath is likely to be down to the person hyperventilating — that is, over-breathing. Again this is part of the fight-or-flight response gone awry.

"Overbreathing blows carbon dioxide [waste gas] from the lungs," says Dr Modi.

This increases levels of oxygen in the lung which is also part of the fight-or-flight response, he adds.

However, it can inadvertently lead to low levels of carbon dioxide in the blood.

"This, in turn, leads to a lowering of calcium in the blood, which causes the tingling in the hands and feet," says Dr Modi.

Because the symptoms overlap so much, "the important thing is to get checked first to make sure it’s not a heart attack — especially the first time it happens," says Mike Ward, "that’s quite crucial".

Dr Modi agrees: "An ECG during symptoms is the most useful way to know which is which, when combined with risk factor assessment [such as age and a family history] and a blood test, to accurately rule out a heart attack.

"In younger individuals, especially women, where heart attacks are less common, it is also important to rule out arrhythmias, especially a condition called SVT (supraventricular tachycardia).

"Often it is caused by a short circuit in the heart’s wiring. This causes symptoms such as palpitations, shortness of breath, chest tightness and light-headedness — and is commonly misdiagnosed as a panic attack." (To rule out an arrhythmia, it may be necessary to wear an ECG device, such as a watch monitor.)

Panic attacks can be caused by obvious reasons, such as being in a car crash or the death of someone close, but can also have more subtle triggers such as getting in a lift or being told to hurry up, particularly in conditions associated with anxiety such as depression, PTSD (post-traumatic stress disorder) or phobias.

Sometimes, as in Kerry’s case, there is no obvious trigger.

However, she says she has suffered from anxiety for "as long as I can remember", and recalls experiencing a racing heart and palpitations sometimes before school as a teen or before taking exams.

As an adult, though, she had believed this was largely under control. "Historically, panic attacks are more commonly seen in women," says Dr Modi.

"Whether this is due to a female predominance or just that women may be more likely to share emotions publicly is debatable."

"The role of oestrogen and progesterone has been raised," adds Dr Jon Bickford, a GP at Broadmoor Hospital in Berkshire, who has a specialist interest in panic attacks.

There is also a theory that there could be a link with differences in the size of a brain area called the amygdala.

"The amygdala, which is almond-sized and lies deeply in the midbrain, plays a central role in our response and regulation of emotions — especially fear," explains Dr Bickford.

Mike Ward says talking therapy such as cognitive behavioural therapy (CBT) might help to prevent future attacks.

"Anti-anxiety medication can also be needed," he adds.

"If someone is really suffering and it’s affecting their work, relationships and home, then therapy might not be enough."

Kerry has continued to have panic attacks. "It can happen in the most innocuous places," she says. "If I am at a soft-play centre with my children or if someone tells me I am in the wrong queue, that can set me off."

She’s now having counselling. "I also take anti-anxiety medication, but that doesn’t stop full-blown attacks," she says.

"I’ve learnt not to fight them as that makes it worse, but to deep breathe and tell myself it will pass: reminding myself it’s not a heart attack, however frightening."

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