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Be Still My Heart: Cardiac Arrest or a Panic Attack?

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I’m an anxious person. My pencils are always gnawed down to nubs, my fingers are constantly drumming on my desk or my steering wheel, and I gave up on regular sleep around 2007. So it really came as no surprise when, during the summer of 2009, I started having panic attacks—sudden onsets of intense fear and physiological symptoms, such as a pounding heart, sweating, and disorientation. As I learned firsthand, panic attacks are bad for many reasons, but their worst feature is their similarity to heart attacks. However, once I learned to tell the difference and realized I wasn’t actually dying every time my pulse began to race, the panic attacks stopped. 

Heart-Stopping Symptoms
According to the American Heart Association, many of us may not be able to recognize a true heart attack when we see one, because we’ve watched too many movies. While a small percentage of heart attacks are “movie heart attacks”—sudden and intense, leaving no doubt about what’s happening—most begin slowly, with mild pain or discomfort. It can be difficult to tell this kind of heart attack from, say, indigestion, and many people who are actually going into cardiac arrest wait too long before getting help, because they aren’t sure of their symptoms. 

Though they vary, the warning signs of a heart attack are: 

  • Chest discomfort. Most people having a heart attack will experience pressure, squeezing, fullness, or pain in the center of their chest that lasts more than a few minutes or goes away and returns.
  • Upper-body discomfort. Heart attack sufferers may also feel pain in one or both arms or in their back, neck, jaw, or stomach.
  • Shortness of breath. This may also accompany chest discomfort.
  • Cold sweat, nausea or vomiting, or lightheadedness. 

Keep in mind that these symptoms are most common in men. Heart attacks present slightly differently in female victims; though women will also feel chest pain or discomfort, they’re more likely to experience some of the other common heart attack features—particularly shortness of breath, nausea or vomiting, and back or jaw pain—as their primary symptoms. 

Hit the Panic Button
You may not know if you or someone next to you is having a heart attack, but you will absolutely know if it’s a panic attack. Panic attacks are sudden and abrupt; they usually last only about ten minutes and will leave you unharmed after they pass. That said, those ten minutes pack a real wallop. Symptoms of a panic attack, according to WebMD, include: 

  • Difficulty breathing
  • Heart pounding
  • Chest pain
  • An intense feeling of terror, especially that you are about to die
  • Dizziness or lightheadedness
  • Tremors or shaking
  • Cold sweats
  • Nausea or stomach cramps
  • Tingling or numbness in the fingers and toes
  • Chills or hot flashes
  • A sensation of choking or suffocating 

People who have panic attacks often suffer from panic disorder, the most characteristic symptom of which is the persistent fear of future panic attacks. This fear can be so intense that it escalates to agoraphobia, or the avoidance of places and situations in which a person has had or believes she might have an attack. 

It’s important to distinguish panic disorder from generalized anxiety. A panic attack is an acute fear response that is disproportionate with a non-life-threatening situation. It’s a misfired fight-or-flight reaction. Over time and with repeated attacks, a person with panic disorder develops a general fear about having attacks that affects her quality of life. 

Don’t Panic! You’re Probably Okay
The irony is that the fact that even when you’re mistaken in believing you’re dying from a heart attack, such thinking will worsen your panic disorder. When you’re caught up in these very real and very frightening sensations, it’s nearly impossible to think objectively, so how can you tell what’s really going on and how best to respond? 

If there’s any question in your mind that your life is in danger, go to the emergency room. It’s better to be safe than sorry, even if you have to spend your afternoon in the hospital, just to be sent home with a clean bill of health. I’ve been that girl, and it seems frivolous in retrospect, but at the time, I absolutely needed someone in a white coat to promise me I wasn’t dying. 

But if you have more than a couple of these episodes, it’s time to start thinking about mindfulness meditation. Jon Kabat-Zinn, founding executive director of the Center for Mindfulness in Medicine, Health Care, and Society and professor emeritus at the University of Massachusetts Medical School, developed the practice of mindfulness-based stress reduction (MBSR), which helps relieve panic disorder, among other stress-related ailments. In his book Full Catastrophe Living, he explains that by becoming aware of our situations and ourselves, we can restore proportion to our reactions. We can also learn to find ease in discomfort. For example, with mindfulness, “Oh no! I can’t breathe! I’m sweating! Am I dying?” sounds more like “I feel hot and am having trouble breathing. I’m having an anxious moment, but it will pass.” 

Be Easy at Heart
When you’re having a spell of full-body discomfort that includes chest pain and lightheadedness, it can be really hard to determine whether you’re having something as serious as a heart attack or as relatively mild as a panic attack. To do so, it helps to understand the symptoms associated with each condition and to understand your own history of anxiety. That’s advice you can take to heart.

Updated on March 15, 2011


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