How do you tell the difference between a heart problem and anxiety?

[KLB32]

I have been diagnosed with OCD, general anxiety disorder and panic disorder. About 3 months after I stopped therapy(in late 2004), I started getting PVC's.  Then one day I was grocery shopping and felt like I was having a heart attack.  I couldn't breathe, was hot and sweaty, my chest felt tight, I felt numb, rapid heart rate/skipped beats and all I could think of was getting out of there. I went to the ER and had an EKG which I was told was normal overall but did show a couple of PVCs.  The Dr. explained to me what PVCs were and told me to follow up with my GP soon to rule out an underlying heart problem.  This was on a Saturday so I called my Dr. that Monday.  He ordered a Holter which showed 45 PVCs and 15 ventricular ecotopies (which I am told is the same thing).  He referred me to a cardiologist who told me PVCs were nothing to worry about in a structurally normal heart and that they were probably anxiety related.  I had an echo which confirmed my heart structure was normal.

Lately, I have been having weird episodes that mimic a heart attack.  I get short of breath, feel weak and tired, heart races/skips, chest pressure, arm pain (sometimes, nausea/heartburn(sometimes) and dizziness.  I have been to the ER 3 times in the last 2 months and am assured I am ok.  The three EKG's I've had have been normal. For some reason, I just can't believe I'm ok.  It happened again today in the middle of church and I had to leave.  I went home and took a Xanax and fell asleep for two hours.  I felt better when I woke up except for the heartburn was still there.  

I'm 32, don't smoke, rarely drink, I'm thin, BP is under control, slightly high cholesterol but my "good" cholesterol is in a good range and my triglycerides are normal.  My parents and brother do not have heart problems.  My grandfather has CAD and wears a pacemaker but his problems did not start until he was about 60.  He's still living.

Does it sound like these "episodes" are just panic attacks?  How can I tell the difference between panic attacks and a real heart attack?

[tickertock]

Panic attacks & true heart problems are very difficult to distinguish even at first presentation in the ER. Usually an EKG , bloodwork, echo, and stress test & holter monitor is enough to rule out significant heart problems. I have had exactly what you're describing since my teens, I'm now 42 & finally feel like I might have these demons under control. It will always the odd person that have true heart problems that are mistaken for panic attacks, but a good trained cardiologist or even a good internist can usually rule out "cardiac" problems quickly.

[PikaPika88]

I don't have to take any medicine.  Went to bed and have a sleep.  Woke up it is all fine.  My cardio told me my heart is normal too.  He told me is anxiety.  Now my GP told me that I have an abnormal structure heart!

Although I've a pacemaker, ER went through a lot of ECGs, blood works and monitoring.  Result was anxiety.  2 months later the echo showed up interior infarction.  My cardio still believed it was kind of muscular skeleton or anxiety.  Now my 2 valves have mild and moderate damaged!  Portion of the heart's wall is not contracting.  He still said every thing looks fine and OK!  I think the cardio only tells you it is not Ok when he needs to put your name into the heart transplant waiting list!  So take care of yourselves and find out.

[Al Dente]

this is a difficult question, and finding the answer can be a long journey.  there is a difference between cardiac pain/heart attacks and anxiety attacks.

some symptoms can mimic each other--I would never allow a cardiologist nor any other physician or health care professional try to rule out a cardiac problem based on a sole or even multiple EKGs--EKGs are normal in nearly 40% of people having heart attacks.  It is of limited value, like a standard stress test.

if you're having an obvious issue, an EKG is of value.  even more sensative diagnostics like echos and even thallium stresses can have negative results when issues are present.  I'd run (or crawl) away from any physician that rules out cardiac problems based on age alone.

as younger people exhibit cardiac symptoms (sometimes they aren't the classic symptoms that older people show) it is going to get more difficult for cardiologists to make clear calls.  if you have a family history or early heart attacks, other heart issues then the symptoms need to be strongly investigated IMO.

if you don't get better despite a treatment prescribed, all the more reason to question--and get copies of every test you've had done.  i have a feeling (from personal experience) that early cardiac disease is being underdiagnosed.

i'm alive today because a 2 doctors found my lipid problems in my teens and "formally" informed my PCP at the time that it was necessary for treatment--which has saved me from a more difficult time than i already experience.

[dmil241]

You have had an echo which showed that you have a structurally normal heart. You do not have a strong, family history of heart disease and you have a history of anxiety. You can trust your doctors. They have years of training. Yes, they can make mistakes. They are not God. However what you describe does sound like panic attacks. When you have an attack, try to remember the testing that you have had and see if you can talk yourself down from your heightened anxiety. Fear is a life robber and it can cycle upon itself. Good Luck!

[fearfactor]

As a person who has suffered from anxiety my whole life, and panic attacks since age 11 or 12, I can tell you that what you describe sounds SO much like a panic attack to me!  I have the same symptoms - in fact on Saturday we were at an art show and I started feeling incredibly dizzy, like I'd pass out, couldn't breathe, my heart started beating like lead (it would normally race, but I now take beta blockers), my vision even went all blurry and I had the feeling I need to get out of here and FAST!  It often happens to me in public, like in malls, grocery stores, places where large numbers of people are like church.  I have PACs which terrify me and are definitely worse when I am anxious.  I took a Xanax after that episode and it helped a lot so I assumed it's just anxiety.  I often worry it's not anxiety like everyone is saying but I really am dying, but I took the Xanax to sort of "test" myself.  I said well, if this helps then I will assume it is anxiety and it did help so I believe more now that it really is just fear.  

[anacyde]

I'm going to ditto tickertock and fearfactor here big time.

I'm also an anxiety sufferer, and I had no idea how they could distinguish panic from heart attack.  Doctors can, but it's not so easy for us.  I asked my father and grandmother once, and both said to me, "You'll know.  It's different.  It's way different.  You won't just be wondering if...you'll know."  That sort of calmed my fears.

[jannie627]

I am a 62 YO female who is about 70 pounds overweight and being treated for hypertension (well controlled) and GERD.  Anxiety and GERD together really mimic heart attack symptoms.  I have been under tremendous pressure lately, both professionally and personally.  My husband just had a quadruple bypass (he was almost without symptoms, but has been diabetic for many years)!  Now I am experiencing "cardiac" symptoms several times daily.  My doc is willing to run me through a nuclear stress test (I passed an echo stress test with flying colors two or three years ago).  My cholesterol is well controlled with Lipitor, but my husband has never had elevated cholesterol.  Xanax and gardening really help, but the anxiety creeps up and the symptoms are scary. I hate this!

[kimmie28]

try a cardiac massage during one of these episodes rub the palm of your hand gently in circles on the right side of your neck this could reduce the feelings and calm your body down.

[oldie]

I had panic attacks for years and discovered I could stop them with a double rum. I then was prescribed .25 Tafil (alpzolam, like Xanax etc) under the tongue for quick results . As needed. Not every day. It works. I miss the rum though!
oldie