When Panic Feels Like a Heart Attack: What’s Happening in Your Body

By La Lune Integrative Psychiatry
Medically Reviewed by Elita Wong, PMHNP-BC

The first time it happens, it can feel like the floor drops out beneath you.

Your chest tightens, your heart pounds, and every instinct says something is wrong. Later, you might learn that what felt life-threatening was a panic attack, but in the moment, it’s hard to tell the difference.

That overlap is one reason so many people experiencing intense anxiety end up in urgent-care clinics or emergency departments. The physical sensations are real and distressing. Understanding what’s happening inside your body can reduce fear and help you know when to seek medical care, and when psychiatric support may be the next step toward relief.

At La Lune Integrative Psychiatry, our clinicians often meet patients after this very experience, once the cardiac workup comes back normal, but the fear and confusion remain. We wrote this guide to explain why anxiety can feel so physical, what clinicians look for when evaluating chest pain, and how integrative psychiatric care can help you regain a sense of calm and confidence in your body.

Why Panic Attacks Can Feel Like a Heart Attack

A panic attack is the body’s fight-or-flight system activating at the wrong time. When the brain perceives danger, even without an external threat, the sympathetic nervous system releases adrenaline and cortisol. These stress hormones prepare you to act: heart rate rises, breathing quickens, and muscles tense.

The result? Sensations that can easily be mistaken for a heart problem:

• Chest pressure or tightness

• Palpitations or rapid heartbeat

• Shortness of breath

• Dizziness or tingling

• Sweating and trembling

For someone unaware that this is a stress response, those symptoms signal catastrophe. The brain interprets the body’s alarm as proof of danger (“my heart is failing”) which triggers even more adrenaline. This spiral can escalate within minutes, peaking and subsiding in 10–20 minutes, though exhaustion can linger for hours.

How Health Care Providers Tell the Difference

Only a medical evaluation—often including an ECG, labs, history, and exam—can rule out heart disease and serious cardiac events. Because missing a cardiac event can be fatal, emergency guidelines advise getting checked for any new, severe, or unexplained chest pain (American Heart Association, 2024).

Still, there are a few patterns clinicians consider when distinguishing between a panic attack and a possible heart problem:

• Onset: Panic attacks often begin suddenly and can occur at rest or during periods of emotional stress. Heart-related symptoms may start more gradually, may follow physical exertion, or can come on abruptly but with a different quality.

• Duration: Panic symptoms typically peak within 10–30 minutes and then ease. Cardiac-related discomfort typically lasts longer, may fluctuate, and can intensify over time rather than easing on its own.

• Quality of pain: Chest discomfort during a panic attack is often described as sharp, tight, stabbing, or fleeting, and it may shift with movement or breathing. It can also feel like a sudden jolt of pain that comes and goes as anxiety rises and falls.

Heart attack discomfort is more commonly described as a pressure, squeezing, fullness, or heaviness in the chest. It may feel more constant, and it can radiate to the arm, jaw, neck, back, or shoulder. This type of pain is often associated with physical strain, does not typically improve with position changes or deep breathing, and may worsen over time.

• Associated symptoms: Panic attacks often involve dizziness, tingling sensations, trembling, shortness of breath, chest tightness, a racing heart, and a strong sense of impending doom. These symptoms typically peak within minutes and may be accompanied by feeling detached from oneself (derealization or depersonalization).

Heart attacks can overlap with some of these symptoms, but they may also include pressure or squeezing chest discomfort, pain that radiates to the arm, jaw, neck, back, or shoulder, nausea, vomiting, cold sweats, lightheadedness, or unusual fatigue. Symptoms may come on suddenly or gradually and can persist or worsen over time, rather than resolving quickly.

• After testing: In panic attacks, ECG results and cardiac biomarkers (like troponin) are typically normal. In heart attacks, there are usually changes in the ECG or elevated cardiac biomarkers that indicate heart muscle injury.

These differences can guide clinicians, but they’re not definitive. Because symptoms can overlap, any new, severe, or unexplained chest pain should be evaluated urgently. Once a cardiac issue is ruled out, follow-up with a mental health professional can help address the anxiety that may be triggering these physical sensations.

Why Panic Hurts So Much (Even When the Heart Is Healthy)

Even after medical reassurance, many people describe their panic episodes as traumatic. That’s because panic floods the body with physiological signals of danger: rapid breathing can lower carbon dioxide levels, causing dizziness and chest discomfort. Chest-wall muscles tighten from tension, adding pain that feels like a cardiac event. And the amygdala (the brain’s fear center) records the event as life-threatening, priming you to notice every flutter or twinge afterward.

What to Do in the Moment (After You’ve Been Medically Cleared)

1. Slow your breathing. Try the 4-7-8 or box-breathing method. Restoring CO₂ balance, especially after hyperventilation, calms the body faster than thought-based reassurance alone.

2. Ground in your senses. Name five things you see, four you can touch, three you hear, two you smell, one you taste.

3. Relax the chest and shoulders. Gentle stretching or pressing your hand to your chest reminds your brain that muscles, not arteries, are tight.

4. Label the experience. “This is panic. My heart’s been checked. It will pass.”

5. Seek follow-up care. Recurrent panic attacks are highly treatable, often responding well to a combination of therapy and medication management.

When to Seek Immediate Care

Go to the emergency department or call 911 if:

• Chest pain is new, severe, or accompanied by fainting, nausea, or radiating pain.

• Symptoms occur during physical activity or don’t ease within 20–30 minutes.

• You have known heart disease, high blood pressure, diabetes, or strong family history.

• Pain, weakness, or numbness affects only one side of the body.

If there’s any uncertainty, it’s always safest to be checked by a medical professional. Prompt evaluation can rule out heart disease and, once cleared, allow you to focus on managing the anxiety that may underlie future episodes.

How La Lune Integrative Psychiatry Can Help

After your heart has been medically cleared, La Lune’s providers can help you understand and manage what’s happening internally. Our approach integrates:

• Therapy and medication management with optional longer sessions.

• Education on body-based anxiety responses so symptoms feel less mysterious.

• Lifestyle and nutritional support to reduce triggers such as caffeine, sleep loss, or blood-sugar fluctuations.

• Mind-body techniques to retrain the nervous system’s stress response.

When your mind interprets every heartbeat as danger, care that connects body and brain can restore a sense of safety.

This information is for general educational purposes and is not a substitute for medical advice. Always seek emergency care if you suspect a heart or medical emergency.

Schedule a Holistic Psychiatric Evaluation Today

At La Lune Integrative Psychiatry, we understand how overwhelming it can feel when your body sounds an alarm you don’t fully understand. Our clinicians combine medical insight with compassionate, evidence-based care to help you make sense of what’s happening — both physiologically and emotionally.

Whether you’ve recently been evaluated for chest pain, are living with recurrent panic attacks, or simply want to understand your anxiety symptoms more deeply, our integrative team can help. We consider your history, lifestyle, relationships, and biology to create a care plan that restores confidence in your body and calm to your mind.

Our providers across Arizona, Colorado, Oregon, Washington, and New Hampshire offer both therapy and medication management — often in the same visit — so you can feel supported in every step of your recovery.

Complete our quick 5-minute intake to get connected with a provider today!