Chest Pain: Heart Attack, Panic Attack or Indigestion?

Heart-related chest pain is often caused by coronary artery disease, a condition in which plaque builds up inside the coronary arteries and reduces blood flow to the heart. Over time, this restricted circulation can increase the risk of a heart attack, especially if an artery becomes suddenly blocked.

Common symptoms of a heart attack include:

• Chest pain, pressure or discomfort
• Chest tightness or heaviness
• Shortness of breath
• Sweating
• Nausea or vomiting

Other symptoms may also occur, such as:

• Pain radiating to the arm, jaw, neck or back
• Lightheadedness or unusual fatigue

In women, heart attack symptoms are often less typical and may be easier to overlook, making awareness especially important.

“Both men and women may have chest pain and shortness of breath during a heart attack, but women also may have nausea, significant fatigue, lightheadedness or an upset stomach that starts up to a month before,” says Todd Hitchcock, MD, a cardiologist at Scripps Clinic Carmel Valley.

Several factors can increase the risk of coronary artery disease, including:

• High blood pressure
• High cholesterol
• Diabetes
• Smoking
• Obesity
• Lack of physical activity
• Chronic stress
• Family history of heart disease
• Older age

While heart attacks become more common with age, they can occur at any stage of life, especially when multiple risk factors are present.

If you think you are experiencing a heart attack, call 911 right away. Don't wait to see if symptoms go away. Emergency responders can start treatment right away. Early care can save heart muscle and lives.

Panic attacks and heart attacks can feel frighteningly familiar.

A panic attack is a sudden surge of intense fear that often comes without warning. Symptoms may include chest tightness, trouble breathing, a racing heart, nausea, sweating and trembling. Unlike heart attacks, panic attacks usually do not cause pain that radiates to the arm, back, neck or jaw.

Symptoms typically peak within minutes and resolve within 10 minutes or more. Panic attacks do not cause heart attacks, but the sensations can be difficult to tell apart, especially the first time they occur.

These episodes may happen occasionally or frequently. Recurring episodes may indicate a panic disorder. If you experience these symptoms and have never had an episode like this before, seek emergency care to rule out a serious heart condition.

For people who experience them often, counseling, relaxation techniques and, in some cases, medication can help reduce symptoms and improve quality of life.

Panic symptoms and severe anxiety can overlap. These include chest discomfort and shortness of breath. The main difference is how quickly they start and how intense they feel.

Panic attacks come on suddenly, peak in minutes, and often feel overwhelming. Severe anxiety builds up slowly due to stress and can last much longer.

Indigestion can mimic heart attack symptoms, causing chest discomfort from stomach acid irritating the esophagus.

Indigestion often causes a burning feeling in the chest or upper stomach after eating, especially high-fat meals or acidic foods like spicy dishes, tomato sauces, citrus, coffee or chocolate.

Reflux symptoms can improve with some simple lifestyle changes. You can avoid trigger foods, eat smaller meals, stay upright and avoid lying down after eating. However, indigestion-like symptoms can sometimes hide a more serious problem.

“Some symptoms of a heart attack may feel like indigestion, especially among women,” Dr. Hitchcock says. “If your acid reflux symptoms seem associated with activity or exertion rather than food or drink, you should get checked for cardiac issues just to be on the safe side.”

Chest pain can also come from the muscles, bones or cartilage in the chest wall. A strained muscle, inflamed rib joints or a minor injury may cause sharp discomfort that worsens with movement, deep breathing or pressure on the area.

While this type of pain is often not related to the heart, it can be difficult to tell the difference. Any new, severe or unexplained chest pain should be checked by a medical professional right away.

When in doubt, it’s always safest to get checked right away. Chest pain or discomfort can have many causes and early evaluation is especially important because prompt treatment for a heart attack can protect heart muscle and improve outcomes.

Don’t ignore symptoms that are new, severe or concerning. If you think you may be having a heart attack, call 911 right away. Getting care quickly can save lives.

Emergency teams in the hospital can quickly evaluate your symptoms and determine whether they are related to the heart or due to another common cause, such as reflux, anxiety or a chest wall strain.