Panic attack symptoms: panic vs heart attack, and what to do during one

Panic attack symptoms: what an attack feels like and how long it lasts

Panic attack symptoms strike suddenly: intense fear or severe distress with no clear real danger, plus a flood of strong physical sensations. The US National Institute of Mental Health (NIMH) describes it as a sudden feeling of fear or loss of control even with no apparent threat. Symptoms peak quickly, usually within ten minutes according to Cleveland Clinic; an attack usually lasts 5 to 20 minutes, though in some cases up to an hour, as the UK's NHS notes.

The most common panic attack symptoms, as listed by the American Psychiatric Association (APA) and NIMH, are:

• A pounding or racing heart (palpitations)
• Shortness of breath, a choking feeling, or a sense that you can't get enough air
• Chest pain or pressure
• Trembling or shaking, sweating, or chills and hot flushes
• Dizziness, light-headedness, or feeling you are about to faint
• Numbness or tingling in your hands
• Nausea, stomach cramps or an upset stomach
• Feeling detached from yourself or from your surroundings
• Fear of dying or of losing control

You don't need all of these; a handful is enough to make an attack, and the attack ends on its own.

Panic disorder is not rare. Based on the US National Comorbidity Survey Replication (2001–2003), NIMH estimates that about 2.7% of US adults had panic disorder in the year before the survey and 4.7% at some point in their lives, with a higher past-year rate among women (3.8%) than men (1.6%). The American Psychiatric Association notes that the average age at which panic disorder begins is 20 to 24.

Why does it feel like you're dying? Panic attack vs heart attack

What happens during an attack is an ancient alarm system built to protect you from real danger: your heart speeds up to pump blood, your breathing quickens and your muscles tense, ready to run or fight. The NHS explains that fear makes your body release stress hormones such as adrenaline and cortisol, so your heart races and you sweat more. In a panic attack, the alarm simply goes off with no fire.

You then notice the dizziness, tingling and chest tightness and read them as a sign that you are dying or your heart is stopping. The fear feeds the symptoms and the symptoms feed the fear. This closed loop is the core of a panic attack, and treatment aims to break it. The NHS stresses that panic attacks are frightening but not dangerous and do not cause physical harm.

So how can I tell a panic attack from a heart attack?

The honest answer: you can't settle this yourself, and shouldn't try. Cleveland Clinic notes that a panic attack can feel like a heart attack, and the NHS says heart attack chest pain may feel like crushing or squeezing on the chest and may spread to your arm, neck and jaw, with shortness of breath, sweating, nausea, and pale, blue or gray skin. Several of these overlap with a panic attack. Cleveland Clinic advises emergency medical care for chest pain, trouble breathing or fainting. So the safe rule: if it is your first attack, if the pain feels different from your usual attacks, or if you have any doubt, get medical help straight away.

Cleveland Clinic notes that a doctor may order tests to rule out conditions with similar symptoms, such as heart disease, thyroid problems and breathing problems, before diagnosing panic attacks. Once a doctor has checked your heart, repeated tests and emergency visits bring only temporary reassurance and don't treat the root of the problem. Also read about the physical symptoms of anxiety.

Nocturnal panic attacks: why do you wake up terrified?

A nocturnal panic attack wakes you suddenly from sleep with a pounding heart, shortness of breath and intense fear, and you stay aware of these symptoms once awake. Cleveland Clinic says they are common: up to 7 in 10 people with panic disorder also have attacks at night. Symptoms peak in under ten minutes and then ease, although getting back to sleep can take a while.

They are easy to confuse with other night-time events:

• A nightmare is a bad dream that wakes you and that you can usually remember, as the NHS explains; the fear comes from the dream. A nocturnal panic attack, Cleveland Clinic says, brings the same symptoms as a daytime attack.
• Night terrors happen while the person is still asleep. The NHS says they are rarely remembered and mainly affect children. A panic attack, by contrast, wakes you and you stay aware of the fear and the symptoms, as Cleveland Clinic explains.
• Sleep disorders: Cleveland Clinic lists insomnia and sleep apnea among the risk factors linked to nocturnal panic attacks.

Fear of an attack can become a problem in itself. Cleveland Clinic notes that worrying about a nocturnal attack can lead a person to put off going to sleep or cause insomnia. If that sounds like you, read about chronic insomnia, and don't turn to sleeping pills on your own.

What to do during a panic attack: steps to get through it

If you're looking for how to stop a panic attack, fighting it won't work. The goal is to get through it with as little harm as possible until it burns out on its own. The NHS advises staying where you are if you can, breathing slowly and deeply, reminding yourself it will pass, focusing on calm, comforting images, and remembering it is not life-threatening.

1. Stay where you are and don't run. Escaping brings a few minutes of relief but teaches your brain that the place really is dangerous, so the list of places you avoid grows.
2. Breathe slowly and deeply. Breathe in gently through your nose, then out slowly through your mouth, at a calm, steady pace. Cleveland Clinic lists deep breathing among the ways to cope with panic attacks.
3. Anchor your attention in the room. Cleveland Clinic suggests mindfulness, bringing your attention back to the present moment. One simple way: silently name five things you can see, four you can hear and three you can touch.
4. Name what is happening. Tell yourself: "This is a panic attack. I know it. It will peak and then pass, and it won't hurt me."
5. Don't check your pulse or keep feeling your chest. Searching for danger signs tends to feed the fear.
6. Look after yourself afterward. Drink some water and rest a little, then go back to what you were doing if you can, so the place doesn't become linked with fear.

How to help someone who is having a panic attack

Family are often the first to see an attack, and your reaction makes a big difference:

• Stay with them and calm yourself first; a calm voice signals safety faster than any words.
• Tell them clearly and simply: "I'm here with you. You're safe. This is a panic attack and it will pass."
• Don't say "calm down" or "there's nothing wrong" in a dismissive tone, and don't mock them or accuse them of exaggerating.
• Give them something simple to focus on: counting slowly with you, or breathing with you at a calm pace.
• Reduce crowding and loud noise if you can, and ask what they need instead of assuming.
• Once they are calm, encourage them to book a psychiatric appointment instead of facing the next attack alone.
• If it is their first ever attack, or there are signs pointing to the heart, get medical help straight away.

When do panic attacks become panic disorder, and when should you get help?

Many people have a single panic attack in their lives, and it doesn't necessarily mean an illness. Panic disorder is diagnosed by a doctor when attacks keep happening without an expected cause, and the person then spends a month or more worrying about another attack or what it means, or changes their behavior to avoid situations they think might trigger one, as NIMH and Cleveland Clinic explain.

Avoidance is what really shrinks your life. The NHS warns that a person may start avoiding certain situations for fear of triggering another attack, and that panic disorder raises the risk of agoraphobia, other phobias, and alcohol or drug problems. You give up public transport, then crowds, then going out alone, until home becomes the only safe place. That is why what counts is not how many attacks you have but what they have done to your life. Get help if:

• The attacks keep coming back, or you live in constant fear of the next one
• You have started avoiding places, transport or situations for fear of an attack
• The attacks are affecting your work, studies, relationships or sleep
• They come with a persistently low mood or withdrawal from people
• You have turned to alcohol, sedatives or any other substance to calm the fear
• You have had thoughts of harming yourself or a feeling that life is unbearable

If fear of dying or of serious illness follows you between attacks too, pushing you to repeat tests and ask doctors again and again, read about health anxiety and the fear of death.

What triggers panic attacks? Caffeine, late nights, smoking and alcohol

Often there is no clear cause for an attack, as Cleveland Clinic notes, and for some people the fear of having one is enough to set it off. But some things prepare the ground:

• Caffeine, smoking and alcohol: Cleveland Clinic and the NHS advise avoiding them, as they can worsen panic attacks. Never stop heavy drinking suddenly without medical supervision.
• Too little or disrupted sleep: Cleveland Clinic notes that a lack of sleep can add to anxiety and stress and make daytime panic attacks more frequent.
• Turning to alcohol, cigarettes or drugs to calm down: the NHS advises against using them to ease anxiety, as they can contribute to worsening mental health.
• Some herbal supplements and over-the-counter medicines: Cleveland Clinic recommends discussing them with your doctor, as certain substances can increase anxiety.
• Suddenly stopping a benzodiazepine sedative you have been taking for a while: the US Food and Drug Administration (FDA) warns that stopping these medicines suddenly or cutting down too quickly can cause withdrawal reactions, including panic attacks and seizures that can be life-threatening. Never stop a medicine on your own; any reduction should be gradual, planned and supervised by your doctor.

Panic attack treatment: CBT, exposure therapy and medication

The reassuring news: panic disorder has clear, well-studied treatments. NIMH explains that treatment involves psychotherapy, medication or both, and your doctor weighs them up for your situation.

• Cognitive behavioral therapy (CBT): according to NIMH, it helps you change how you think about, act on and respond to the feelings that build up before or during an attack. It explains what happens in your body, corrects the frightening reading of the symptoms, and helps you drop the "safety" behaviors that keep fear alive.
• Exposure therapy: gradual, structured facing of the situations and sensations you avoid, until your brain learns from experience that they are not dangerous. NIMH describes it as a common part of CBT for panic disorder, sometimes combined with relaxation exercises and breathing training.
• Medication when needed: a doctor may decide on antidepressants from the selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitor (SNRI) groups, which may take a few weeks to work. Benzodiazepine sedatives may be used for quick, short-term relief only, because the body can get used to them so they work less well, and some people may even become dependent on them, as NIMH cautions. If you have been taking one for a while, read about benzodiazepine and sleeping-pill dependence, and why stopping suddenly is risky.
• Don't start, stop or change a medicine your doctor prescribed on your own, and don't take someone else's prescription because their situation "looks like yours".

At Oxygen Center, the first step is an appointment with a psychiatrist to check for physical causes and establish whether what you are going through is panic disorder. Then comes a plan combining psychotherapy sessions with medication when needed, and regular follow-up until you regain the places and situations you gave up. To start, or to ask about someone you love, contact us any time, day or night.