Heart Attack vs. Panic Attack: How to Tell the Difference with Jacqueline Tamis-Holland, MD

Podcast Transcript

John Horton:

Hello, and welcome to another Health Essentials Podcast. I'm John Horton, your host. Chest pain tends to grab your attention, ditto for a skyrocketing heart rate and a sudden case of the sweats. Put them all together, and you have classic symptoms of, well, two very different things. All of that bodily mayhem could be a sign of a heart attack, but it also could point toward a less-than-life-threatening panic attack. How can you tell the difference? I'm going to break that down today with cardiologist, Jacqueline Tamis-Holland. She's one of the many experts at Cleveland Clinic who pop into our weekly podcast to help you better understand how your body works. So with that, let's find out whether that chest pain is your heart sending out an SOS, or your anxiety calling out for attention.

Welcome to the podcast, Dr. Tamis-Holland. We are always overjoyed to get time with someone from the number one heart hospital in the United States.

Dr. Jacqueline Tamis-Holland:

Well, thank you, John. I'm really excited to be here today.

John Horton:

Well, before we dive into today's topic, I wanted to spend a minute and look toward the future of cardiac care, and specifically the amount of time that you spend mentoring the next generation of heart doctors. Confession. I was creeping on some of your social media accounts and you spend a lot of time working with young doctors and it really struck me. Why is this such a passion for you?

Dr. Jacqueline Tamis-Holland:

Yeah, that's great to ask. I love working with this younger generation, and that's not even just the doctors, but the medical students, the college students, and even high school students. I feel that a lot has been done for me throughout my career and now we use the saying, "Pay it forward." So I really like to work with the younger generation to sort of help guide them, and they've really taught me so much. Taught me so much in terms of the way they handle things professionally and their response, and they've taught me a lot about AI and computer-related things and software, so I learn a lot from them. But it's just great to see them work, to work with them. And they all have different passions and I think the future of cardiology and the future of medicine is not necessarily all going to be focused on specific patient-patient interaction. So everybody has a different skill set, whether it be AI or understanding of research or clinical care, and I love working with each of them for their own reasons.

John Horton:

Well, that is good news for all of us. And clearly, from everything you just said, you're an educator at heart and of the heart, and we're going to lean into that a little bit today while talking about heart attacks and panic attacks, and how tough it can be to tell them apart at times. So to kind of of get us started, why are these two completely different health events often confused?

Dr. Jacqueline Tamis-Holland:

Yeah. So I think they're often confused because in both situations, you have a feeling of impending doom, something doesn't feel quite right, and I think everybody's biggest fear is that they're having a heart attack. And to be perfectly honest, a panic attack is actually even more traumatic, in terms of the way somebody feels.

John Horton:

Wow, yeah.

Dr. Jacqueline Tamis-Holland:

And therefore, in somebody's mind, they are having the real movie-like feelings that they expect to have when they're having a panic attack.

John Horton:

So, what are those symptoms that you get that are kind of similar?

Dr. Jacqueline Tamis-Holland:

Yeah, so for sure, both people with panic attacks and people with heart attacks have some chest discomfort or chest pain, and you might have a sensation of your heart racing or pounding, and certainly, both situations can cause you to feel sweaty and kind of dizzy or unwell and not feeling right, and they both have the same presentation.

John Horton:

Yeah, and you had mentioned that sense of impending doom, which every time I hear that term it's just it's so specific and we all kind of know it, you just get that feeling of dread. That's that strong with both of them?

Dr. Jacqueline Tamis-Holland:

Yeah, so actually, that's sort of what I was trying to get at. The interesting thing is this sense of impending doom and the really feeling awful is actually more dramatic and more commonly seen with a panic attack than with a heart attack. Most people who are having heart attacks are expecting to feel like one might feel with a panic attack. Really dramatic pain, terrible pain, really just feeling awful. When in actuality, it's just a little bit of pressure and they don't recognize it's a heart attack because it's not the dramatic feeling one might have, and that one does have with a panic attack.

John Horton:

Yeah. So I'm guessing then since there's so many similarities, I'm guessing there are some clues that can kind of help people distinguish between a heart attack and a panic attack. So, what are kind of the key signs to tell them apart?

Dr. Jacqueline Tamis-Holland:

Yeah, so let's start with a heart attack. So heart attack classically is more of, we really try to say to ask patients, "Is there a discomfort?" Because if you ask somebody, "Are you having pain?" They'll say, "No, it's not pain." It's usually a discomfort, it can be a pressure or a squeezing or a sensation like something is grabbing you or pressing on you or sitting on you.

John Horton:

I was going to say, yeah, the difference between pain and discomfort seems like it might be in the eye of the beholder, but I mean, there is a line, it sounds like?

Dr. Jacqueline Tamis-Holland:

There is, because most... And then on the other hand, with a panic attack, it might be a really sharp, intense, severe pain. And of course, a heart attack can also be sharp, intense and severe, but a different kind of sensation. It's oftentimes more like a pressure. So patients sometimes who are having heart attack ignore it because it's not dramatic, it's not incredibly severe or incredibly intense, and they don't recognize it. And whereas with a panic attack, it's much more sharp, much more dramatic, and much more intense.

John Horton:

See, that goes against everything we always think about with a heart attack. And maybe it's we've seen too many movies where it always looks so dramatic. So, it sounds like it's much more just you get that, you said that heavy feeling, they always say somebody's sitting on you or something like that.

Dr. Jacqueline Tamis-Holland:

For sure. So you have that, and then a lot of people with heart attacks might have a little bit, a sensation of cold sweats. Sometimes they might have some shortness of breath, and certainly sometimes the discomfort will go down the arm or up to the jaw or up to the throat or neck, and those are sort of common accompanying symptoms, but some people just have the typical pressure and nothing else.

With a panic attack, you'll have more frequently a sense of your heart's racing or pounding along with it, because you're panicking and you're getting nervous and your heart's racing because of that. So you might have more of a sense of heart pounding and you again, might get lightheaded or sort of sweaty because you're so nervous or so upset about something.

John Horton:

Yeah. I think I read under one thing with panic attacks that your heart could start racing up to 200 beats a minute. I mean, that's crazy fast.

Dr. Jacqueline Tamis-Holland:

Yeah, I mean, a panic attack, a pure panic attack will go as high as your heart rate can go given your age. So you're not going to go to 200 a minute if you're a 60-year-old person. If you are a 22-year-old person, you are, it can probably reach upwards of that for just a regular response to being upset. But it can go up high, maybe not quite 200, a little higher if you're younger, not usually that high.

John Horton:

When it occur, I mean, is that a difference between the two of them?

Dr. Jacqueline Tamis-Holland:

Yeah, so the thing with a heart attack is, excuse me, it can occur at any time and so can a panic attack, but usually a panic attack occurs when you're in the setting of feeling unwell mentally about something, like you're very distressed or anxious about something and then it happens. Although, some people with panic attack might have a panic attack for no particular reason all of a sudden, and heart attacks too, generally occur all of a sudden without any precipitating factor. So, it's hard, I wouldn't really distinguish the two based on that because they can both occur all of a sudden, but panic attacks, you would expect that there's something going on that's bothering you mentally. Like you've been bothered for the last couple of days, or you're bothered at that point because you just have a fight, fight with somebody, or you're anxious about something.

John Horton:

Yeah. So this sounds like there's usually a trigger with a panic attack, something that gets things going a little bit.

Dr. Jacqueline Tamis-Holland:

Yes, exactly.

John Horton:

Heart attacks can just come out of the blue.

Dr. Jacqueline Tamis-Holland:

Exactly.

John Horton:

Okay. Is there a difference with how long they might last too? Or is one real quick, the other one kind of lingers?

Dr. Jacqueline Tamis-Holland:

Yeah, so well, a heart attack will last until you seek medical attention and if it's a type of heart attack called a STEMI, which is where it's because of a totally blocked artery, it's not going to get better until you open that artery. So it can last for minutes, generally it starts as minutes, and then we ask you to call 911, so it can last hours until that artery gets opened or until you seek medical care. But the panic attack is probably a finite amount of time, because you're going through this distress, you're in panic, and it lasts for a period of time until you can calm yourself down and feel better about things. So it might be a shorter, it'll be a shorter period of time. It's not going to last for hours, generally.

John Horton:

Now, but you always hear people talk about silent heart attacks or things like that, which always blows my mind that something could be that mild and people just kind of wave it off. Is that where it gets difficult to distinguish between whether it's a heart attack or a panic attack?

Dr. Jacqueline Tamis-Holland:

I think that both a heart attack and a panic attack generally have symptoms, but in patients who find out later that they've had a silent heart attack, they might look back and retrospectively say, "Oh, yes, I remember two weeks ago I did have this feeling. I thought I had eaten too much Mexican food that evening, and therefore, I just took a Tums and went to sleep." And so sometimes silent heart attacks are just incidentally discovered heart attacks, and in retrospect, somebody remembers an event that probably led to it. Other times it's totally silent, they just didn't even realize it until they found it on an EKG.

John Horton:

Wow. Now, I always want to bring up when we're talking about heart attacks, that there are differences in the symptoms that men and women feel. And I always feel like that's important to kind of emphasize and bring up just so that way people know, hey, there are some different signs here. So, can you kind of break that down for us?

Dr. Jacqueline Tamis-Holland:

Yeah. So there are definitely differences, and we know that women are more likely to have accompanying atypical symptoms. But to be perfectly honest, I really want to be very emphatic about stating that women and men are both equally as likely to have chest pain. But in addition to chest pain or chest discomfort or pressure, in addition to that, women are more likely to have other symptoms with it, or sometimes they're more likely to have, depending on the study, more likely to have atypical symptoms. So that could include burning or epigastric pain, so pain in the stomach area, or it can include just plain shortness of breath or sweating or nausea without pain. But women do have chest pain as a typical or chest discomfort as a typical presenting symptom, it's just that sometimes they have other features as well.

John Horton:

All right. And it sounds like the men are less likely to have those other symptoms, but as always is the case, it seems like that's not a hard and fast rule and it can be different person to person.

Dr. Jacqueline Tamis-Holland:

Exactly. When you do look at atypical features, women are more likely to have atypical features with their presentation.

John Horton:

So whether you're dealing with a heart attack or a panic attack, I think we can all agree that chest pain in general, wherever it's coming from, is pretty terrifying. What's the best way to kind of decode the message that your body is sending?

Dr. Jacqueline Tamis-Holland:

Yeah, so that's really a great question. It's really hard, because as a practical cardiologist, I don't want to be sending everybody with chest pain to the emergency room. But our typical recommendations are that if you're feeling chest discomfort or chest pain and it's lasting more than 10 minutes, you need to call 911. That being said, I think you also want to recognize what you're feeling.

So first and foremost, if it's an unusual symptom that you've never felt before and it's lasting more than 10 minutes, you should be calling 911. But things that I think would be of concern to me is if you have this pressure squeezing, burning type of pain, it's lasting a period of time, and you're feeling sweats with this or you're nauseated, those are very sort of classical together a symptom of a heart attack and you should be calling 911.

John Horton:

Yeah. Do you find, do a lot of people actually just wave those sort of symptoms off and go, "Ah, it's nothing," and they kind of ignore it?

Dr. Jacqueline Tamis-Holland:

Absolutely, absolutely. So many people say, "Oh, I just thought it was indigestion and I took a Tums and waited half an hour to see if it would go away. And then when it didn't go away, then I called 911 or then I went to the hospital." So it's very common for people to not recognize that. And in fact, when you talk about women and men, women are less likely to recognize that their symptoms are a heart attack than men. When you interview women and men after they've had a heart attack and you've asked them if they sort of waited before they sought medical attention. There's some studies that have shown that women are more likely to wait before they call 911 than men because they didn't recognize it was a heart attack or they didn't think it was a heart attack, more so than men.

John Horton:

So somebody's on the fence, they're getting some of this chest pain and they're like, "Ah, I don't know." What steps should you immediately do to ensure your safety?

Dr. Jacqueline Tamis-Holland:

Yeah, so I think number one, you want to make sure you're with somebody or somebody's aware that you're not feeling well. And again, I would say that our recommendations and the recommendations from the American Heart Association and all of the societies is that you wait 10 minutes and if the symptoms aren't... Or not that you wait, but if it's going on for more than 10 minutes, you should call 911. A lot of people wait a little bit longer than 10 minutes, they wait 15 or 20, but for the most part, you should call 911. You can certainly take an aspirin, because the ambulance will give you an aspirin if you don't already take aspirin on a daily basis, the ambulance will give you aspirin when they arrive. But the truth of the matter is, I think the most important take-home point is, you should be calling 9 11.

John Horton:

Yeah. I mean, sometimes I think everyone's kind of hesitant to do that a lot, but I mean, there's a reason why they're there waiting for calls, and it's for situations like that.

Dr. Jacqueline Tamis-Holland:

Exactly, and again, I struggle to say this because it could be that you live in an extremely remote area and it's going to take 45 minutes for 911 to come and it's going to be quicker for you to drive there. But in truth is, the recommendations also are that you shouldn't be driving yourself to the hospital if you're having pain or you shouldn't be having a family member drive you because sometimes in route things happen. And that's why if you're in an area where 911 can come to you quickly enough, you should call 911 and not take yourself to the hospital or not have the family member take you to the hospital if you can get there just as quickly with 911, because if something happens in route, the family member cannot help you.

John Horton:

Yeah, that's a great tip because I think sometimes people will just, "Oh, I'll take care of it myself," and if it's going the wrong way, you want to make sure there's people around you who know what to do.

Dr. Jacqueline Tamis-Holland:

Yeah, and the other thing is the ambulance can do an EKG at your bedside. They can come to your house and do an EKG, and then if they recognize a heart attack on the EKG, they phone into the hospital to say, "We're on our way with this patient," so we're preparing our teams and getting ready much earlier than if you walked in. So we get that heads up and head start from there.

John Horton:

Well, and that's where you get to if it is a heart attack, I mean, I know I always hear, every second counts. I mean, it makes a huge difference.

Dr. Jacqueline Tamis-Holland:

It really does, it really does. I mean, you can arrive and literally go straight to the cardiac cath lab if we know ahead of time you're coming.

John Horton:

All right. Let's talk prevention a little bit. I mean, are there any kind lifestyle hacks or habits that can help keep us, I guess, help us avoid heart attacks and panic attacks?

Dr. Jacqueline Tamis-Holland:

Yeah, so I'm going to focus on the heart attack because that's really more of my specialty. Panic attacks, I definitely want to make sure that you're figuring out ways to keep yourself relaxed and so forth. But for heart attacks, I would say that in general, making sure you're living a heart healthy lifestyle is really important. So during exercise, it should be at least 30 minutes of aerobic activity, at least five days a week or 150 minutes of some sort of aerobic activity. I love the Mediterranean diet, that's the thing I basically encourage everybody to follow because it's a doable diet and it's something you can live with that you should be following on a heart healthy diet. And trying to avoid things that are fried food and those hamburgers and those cheeseburgers and bacon and so forth in your diet as a regular thing. If you have it once a month, that's fine.

So I think just maintaining a healthy weight, not smoking, these are things that everybody should be doing, not necessarily somebody who's at risk for heart disease, but if you have those risk factors like high blood pressure or high cholesterol or diabetes, it's really important to work with your doctors to be sure that those are controlled and as best as possible your blood pressure's normal, your cholesterol has gotten better with medications or with diet, and that your sugar is under control because those things will increase your risk. So really, making sure that those things are under control are important.

If you don't know if you have diabetes or high blood pressure because you haven't seen your doctor in five or 10 years, then I would say one important thing is to go to the doctors, your general internist and see what is your sugar, what is your hemoglobin A1C? What is your weight? What is your cholesterol? And what is your blood pressure? Because if you might have these things and not even realize it, and then you really need to know so you can take care of yourself.

John Horton:

Well, and I'd imagine all that plays a role too, if you're having these chest pains. If you know have some of these risk factors, it might help you make that decision a little more quickly as to what you're experiencing.

Dr. Jacqueline Tamis-Holland:

Oh, for sure. Exactly, and that was what I was sort of saying is if you don't recognize you're at risk, you wouldn't recognize that maybe the symptom is a heart attack, it wouldn't even come into your thought process. But if you know you're at risk, then maybe you're going to recognize the symptom a little earlier and seek medical attention.

John Horton:

All right, well, and on the panic attack thing, we'll have to throw that toward Dr. Young. We have her in all the time, that sounds like the perfect topic for her. So we'll tap into her expertise a little bit on that. We'll keep the heart stuff in your realm.

So I guess to wrap everything up, Dr. Tamis-Holland, what's the one thing you want folks to remember if they're ever in a situation where they're trying to decide whether they're experiencing a heart attack or a panic attack?

Dr. Jacqueline Tamis-Holland:

Yeah, so it's tricky and I don't want to put it out there like, oh, don't worry and wait, because if it is a heart attack, I don't want somebody to say, "Well, she said to wait." But the truth is, some people know, you might be extremely young like 18 or 20 or 25 years old or 30 years old, so less likely to have a heart attack, although it's not impossible. And you might be under a great deal of stress, so recognizing what you're feeling, if there's been something going on that's triggering this, that's making you very, very upset or under a lot of stress, you just had a huge fight with somebody, you're afraid that something's going to happen, and then you feel these symptoms and you're not really at risk for heart disease. You calm down, you take some deep breaths, you try to think about something else and it gets better, then it probably is a panic attack.

I really hesitate to say that because I don't want people who are 75 who are perfectly calm all their life to say, "Oh, this might've been a panic attack," but I think it's sort of the right demographic. Somebody who is known to be anxious or known to get upset about things, they're younger, they have less risk factors, and they're feeling this sensation of really sharp pain with shortness of breath. Try to calm down, take some deep breaths, see if you can sort of stop thinking about whatever's bothering you, and maybe if it goes away, then you're a little bit more comfortable. But if it doesn't go away, again, I hate to say it again, but you should call 911.

John Horton:

Yeah, it sounds like you really need to do a true, honest assessment of where you're at and kind of go, could this be a heart attack? And if you even think it might be possible, dial those three numbers that we all know, 911, and get help.

Dr. Jacqueline Tamis-Holland:

I love what you said. You have to, and I say that to my patients. For some of the times they have indigestion and heart-related pain, and I don't want to have to send them to the hospital for every time they have indigestion. So I say this to people all the time, "You really need to know your body, you need to know what's unusual, and you need to know what possible situations you can have." So if you're somebody who always has indigestion, this is your typical indigestion, okay. If you're somebody who has panic attacks, okay. But you need to know your body and know what's normal or typical for you and what's unusual, and know your threshold.

John Horton:

Well, that is great advice, Dr. Tamis-Holland, and we really appreciate you coming in here today and kind of helping everybody get an understanding as to the differences between a heart attack and a panic attack and really, what kind of action you should take. So, thank you very much.

Dr. Jacqueline Tamis-Holland:

Thank you for having me. It was great talking to you.

John Horton:

A heart attack is a medical emergency, a panic attack isn't. Unfortunately, sometimes it can be difficult to tell the two situations apart when chest pain hits. If you're unsure what you're experiencing, get medical care, better safe than sorry. If you liked what you heard today, please hit the subscribe button and leave a comment to share your thoughts. Until next time, be well.

Speaker 3:

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