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

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?
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16 Comments Post a Comment
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84483_tn?1289941537
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.
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88793_tn?1290230777
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.
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Avatar_n_tn
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.
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Avatar_n_tn
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!
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Avatar_f_tn
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.  
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61536_tn?1340701763
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.
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Avatar_n_tn
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!
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505800_tn?1226398193
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.
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Avatar_m_tn
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
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Avatar_n_tn
hi im a 25 year old male and for the past 6 months iv been struggling with a tight chest, due to tension and stress acording to my docs.
I get pain in the left side and right at the top of my chest it feels like something is pushing down on me and its really uncomfortable!
Iv not been to work i hardly go out because of it and i worry its a heart thing, i often have episodes of rapid heartbeat dizziness only tonight i was just watching t.v and i started feeling really cold and all of a sudden i was feeling really il rapid heartbeat etc...i just dont get how this can last so long and come on for no reason??is anyone in a similar boat who would like to talk????please write back ..
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1651043_tn?1301614911
It's anxiety trust me. For over a year I have been fighting this anxiety demon. In & out of the E.R. dozens of medications. I am now proud to say i am anxiety free for the most part. I haven't had an episode in months and I'm not taking anything at all. Something triggered your anxiety and you've trained your mind to be anxious all the time. Now you have to reverse the process un-learn how to be anxious it sounds crazy but it works. Eating healthy and taking a B2-B12 vitamin complex along with vitamin C will help due to the extra tension on your adrenal glands from anxiety. Keep a note pad and write down every time you get anxious and what caused it if there was a cause at all. Pressure points are a good way to stop anxiety in the middle of an attack. I found out my anxiety was associated with my heart every time my HR was elevated i would get anxiety. You need to face your demons. The first step to recovery was I ran on a treadmill as fast as i could for 10 minutes. I thought I was going to die but after I was still alive. You need to tackle your trigger head on or your anxiety will lead to depression and agoraphobia. I hit rock bottom and made it back to the top and so can you. -Eric
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Avatar_f_tn
Wow anxiety is so nerve wrecking but like seanjohn said it is very possible to get control of it without medication. With the help of God we have to learn to control our fears once the serious stuff has been ruled out. If you have panic attacks more than 10 times by now you should be able to tell yourself ok I didn't die r have a heart attack the last 10 times so i'm going to be ok. Fear is "false evidence appearing real", so unless the doctor tells you that its your heart try to stay calm and talk yourself out of a panic attack. I've also found that keeping a journal helps alot also. Try jotting down how you feel and what brought it on.
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Avatar_m_tn
How reliable / good are 7 day heart rate monitors to check if you have a problem? I had it done, tests came back basically ok. They put it down to anxiety, every time i sit my pulse is ok 60-80bpm, when i stand it jumps 110-120bpm. Can this be anxiety e.g. when i sit my heart rate is fine but when i stand it goes up - because im thinking it will??
If i had a 7 day monitor and blood tests would i need further tests or just beleive the GP?
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Avatar_n_tn
I go through the same thing, i swear i have a heart condition and they say my heart is normal. ive been dealing with these things since im about 14 and im now 30. been on and off alprazolam and now since i had my baby 6 months ago their alot different like a thumping heart beat where it feels like my heart is skipping a beat, its sooo scary annoying and i feel like their missdiagnosing me. one thing i will say when i take the alprazalam i do feel better it hepls but y should i have to take something everyday you know? i really try hard to work it out myself but it comes to a point where ur like wtf! so, i dont know, im gonna go back to the heart doc and see what else he can do for me cause the pannic attacks are different then they were before now its this skipped heart beat thing which i never had before.. good luck!
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Avatar_m_tn
Yes mate i have been suffering exsacly the same for 12 months now dailey have had my bloods checjed 3 ecg.s and a 24 hour tape docs all say its anxiyity but i just cant belive them it feels so bad
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Avatar_f_tn
Have your doctor check your potassium levels. This is not check often enough and can cause many of the issues you speak of. Cut back on process foods- even out to eat, and start adding more potassium foods- Oranges, Kale, chicken thighs, plain yogurt, just to name a few.  
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Avatar_f_tn
One more thing, have them also check your magnesium levels. You need 1/2 the amount that you get from calcium. Both of these help relax you.
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Avatar_f_tn
I have had anxiety for years, which made me think i was having a heart attack which was scary, but i recently really did have a heart attack, and didnt even know it. Happened to be in hospital for some thing else. Now, everytime i do get anxiety, i am fearful it may be a heart attack. How can i know the difference? I can't run and get checked everytime or id be in the er every day. dont know what to do. It driving me crazy.
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Avatar_f_tn
Hello not sure how old this is or if anyone will read it but it's worth a try. I am a 21 ur old female I had my first panic attack at 18 which I was convinced was a heart attack and followed up with my family doc which referred me to a cardiologist just to shut me up the cardio then sent me to an electrophysiologist who diagnosed me with an over active sa node and put Me on a beta blocker all was well until I turned 21 everything came flooding back the anxiety and panic and er trips every second of the day I think I'm going to die I'm scared all day unless I am asleep my biggest question would be is this my heart or my panic disorder pray for me
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Avatar_f_tn
I have a question for those diagnosed with anxiety attacks, after the attack do you feel completely exhausted and a headache that feels like someone is squeezing your brain?  My episodes start by feeling my heart flip flop, than my heart beats very rapid and then I start yawning uncontrollably, really Long deep yawns as if I can't get enough oxygen, my chest feels tight and as if it's being squeezed.  After these syptoms (symptoms) have passed I feel so tired and want to sleep.  I've had all the usual tests and other than a mitral valve click I was told there was nothing wrong.  My Dr started me on Bata-blockers, but they made everything worse and I had real chest pain and shortness of breath.  Not sure where to go from here, any suggestions?
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Avatar_f_tn
I came across something that has been a great help to me. Nasal steroid spray. I never realized first that I had allergies, and second how bad they were.  When I got on this spray, I was able to breath better and this has help my overall feeling, more than I ever thought could be.

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Avatar_f_tn
One more thing, it sounds like you have asthma that is allergy related, which most are. I would try the spray first though.
My ENT told me to use a saline solution( morning and night, or when ever) first then use the spray once a day- I use at night.

Let me know if this helps if you try this.    
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Avatar_f_tn
I just read what you wrote several years ago....it describes me.. I am almost 60, over weight, blood pressure, acid reflux and cholesterol controlled by medications.  But recently I feel that tightness in my chest.   If I'm busy, I don't notice it, but the minute I think about it, it's there.   Mostly I experience these feelings while sleeping!   How did your situation end?  Any help you can give me?  Thanks.   Kathy
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Avatar_f_tn
i've started suffering panic attacks recently after near 4 years.
I'm teaching at a school at the moment and i had a block of three classes in a row.
The symptoms started of as feeling weak and faint so i had something sweet to try pick myself up.. then when i got into class.. i felt unsteady and breathless with a slight pain in my chest.
t one point i thought i'd better cancel the class and home, but i managed to teach all three classes..
god i hate panic attacks.. its as i'm going to literally die but i dont want to ask for help or seem a burden so i just push the fear down inside.

i think i might have to take meds as i cant really do breathing exercises in the middle of teaching a class.

thanks for reading
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Avatar_m_tn
Five years ago, I had a cough that wouldn't go away.   The coughing caused me respiratory problems & chest pain.   The coughing was depriving my body of oxygen, which triggered an anxiety attack.   I had no appetite & lost a bit of weight.  I was later diagnosed with anxiety disorder.  We don't know what  caused the coughing, but somehow it went away & my anxiety got better without medication.  

Recently the chest pain, tightness of chest, shortness of breath & difficulty to swallow came back with no stress in my life.  Especially after a work out or after I finished eating.   I thought I had a heart problem.  Went to my GP and she immediately said I had a anxiety attack, she just based this on experience & my medical history.   She put me on anxiety mediation, which didn't help.  The chest pain went on for weeks & I thought I was going crazy.  

It was due to a heart burn medication commercial on TV,  that the light bulb clicked in my head.   Twenty years ago I had acid reflex with stomach cramps, but no heart burn.   It  went away when I changed my diet.   But twenty years later, I eat what everyone eats.   And forgot my diagnoses when I was 22.  Unknown to me my coughing/ chest pain was triggered acid reflex.     Those symptoms became more frequent.   When I saw the acid reflex commercial, I realized I had all the symptoms and reflected on diet I was eating.   I contacted my GP, and she put on acid reflex meds.  The burning sensation went away within 5-8 days.   I'm not saying that you are misdiagnosed, but sometime Dr.'s are only human.   So it's best to do your own research.  
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Avatar_m_tn
Due to the constant returns of my symptoms of coughing/ chest pain & years of being misdiagnosed.  Stress from those illness has triggered my  anxiety disorder.  It's a very scary thing when no one knows whats going on with you.  My family kept telling me my chest pain is all in my head, due to anxiety.  But I kept telling them, my  chest pain is real & not imaginary.  But the EKG tells me that there's nothing wrong with my heart.   You feel so hopeless when you don't know what's wrong with you & Dr's think your a nut job.  

But now that I know my symptoms of chest pain & coughing is caused by  acid reflex, I have changed my diet/ eating habits.    I'm amazed how many foods out there that triggers acid reflex.   When you have severe acid reflex, the acid can burn your esophagus.  Which creates the burning chest pain, and shortness of breath.  Which can trigger stomach cramping, minor to severe coughing & insomnia.   Years of acid reflex has done its damage to my esophagus.  Even  with the diet change, I still occasionally have heart burn which in turn triggers my anxiety.   I keep a food diary, so whenever I have chest pn, I can go back & monitor what I been eating that could of triggered it.  
I now have a long list of food that I can't eat.  

Make note of your diet of what you eat & how often you eat & what time you eat.    Cause your chest pain can be the cause of  acid reflex & that fear can trigger anxiety.   You can't fix your anxiety if you never fixed the cause of your chest pain.  



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