Does a Racing Heart Rate Always Mean a Panic Attack?

The rapid heart rate and chest pain of a panic attack can be scary. Worrying that it could be something more serious can make the fear even worse. Here's some information that can help when your heart starts galloping in your chest.

A panic attack is a sudden episode of psychological distress, such as the intense fear that something bad is going to happen, accompanied by a range of physical symptoms, says the Anxiety and Depression Association of America.

The most common symptoms are rapid heart rate, difficulty breathing and chest pain, according to the National Library of Medicine. Other symptoms may include a heart-pounding sensation (sometimes called palpitations), sweating, trembling, dizziness or lightheadedness.

If you have repeated panic attacks, you may have what's known as panic disorder, says the American Psychiatric Association. But if you haven't been diagnosed or have never had a panic attack before, it's best to get medical attention to rule out possible physical causes.

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Teasing out whether your rapid heart rate is part of a panic attack or caused by something else can be challenging, says heart rhythm specialist Faisal Merchant, MD, an electrophysiologist and professor at the Emory University School of Medicine in Atlanta. "Is the panic disorder or stress and anxiety causing the high heart rate? Occasionally, people can have high heart rate as a primary problem, and when the heart's racing, that can make you feel stressed and anxious."

There are a number of reasons why you might have a rapid heart rates, says the American Heart Association. Other possible causes that your doctor may consider include:

• Heart attack
• Supraventricular tachycardia (SVT), a heart rhythm problem caused by faulty electrical signals in your heart
• Thyroid problem
• Medical or recreational drugs
• Caffeine intake

Ultimately, Dr. Merchant says, it can be a diagnosis of exclusion. "Once you've done whatever evaluation you need to do to make sure the heart's otherwise normal, that the electricity in the heart is normal, then you can say, 'This fits with a panic attack,' but there's not a specific test that you can do to clearly diagnose someone with a panic attack," he explains.

If other causes are ruled out and you're diagnosed with panic disorder, medications and talk therapy can help, says the American Psychiatric Association. One goal of therapy is to learn strategies for managing stress and relaxing when a panic attack strikes, the association explains.

Oddly, focusing on staying calm isn't one of them. "You can try taking some calming breaths to help you quiet down," says anxiety disorders expert and author Reid Wilson, PhD, director of the Anxiety Disorders Treatment Center in Chapel Hill and Durham, N.C.

"But if you simultaneously tell yourself, 'I must calm down now,' you are going to be working against yourself." Doing so can signal to your amygdala — the part of your brain where the stress response starts — that something is wrong. And that can prompt your body to release epinephrine (also called adrenaline), a hormone that increases your heart rate.

Instead, "don't fight your uncomfortable physical sensations," Wilson says. "Accept them for what they are — a normal bodily reaction to your fearful thoughts of 'danger ahead!'" At the same time, he adds, don't fall for the psychological symptoms. "Once your MD gives you a clean bill of health, challenge the catastrophic thoughts that you're dying or having a heart attack," he says. "Label it as 'panic trying to scare me.'"

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Finally, it can also help to know that the rapid heart rate of a panic attack doesn't cause any damage.

"From the point of view of the heart, that's really no different than if you were to go jogging for 20 minutes," says Dr. Merchant. "Your heart rate would be 160, 170, 180 for the same amount of time. Most of the time, your heart's quite accustomed to beating fast for short periods of time, and there doesn't seem to be any evidence of any long-term damage or anything like that."