Awhile ago my husband complained of a pounding heart. He said it felt like it was thumping against his chest. Tests showed that he was fine and it was probably caused by stress. How can we tell the difference between severe anxiety and a heart attack?
Dr. Gary Milechman is associated with Golden Gate Cardiology at California Pacific Medical Center. He is the Director of the Cardiac Telemetry Teaching Service at CPMC with a commitment to teaching nurses, medical students, medical residents and Cardiology Fellows. Dr. Milechman is also a busy clinician, taking care of a wide range of patients with different cardiac problems.
It is often very difficult to differentiate the symptoms of a heart attack from other causes. Even in the Emergency Department, with access to X-rays, EKG’s, and fancy lab work, we sometimes cannot be 100% certain.
Severe anxiety can cause a sense of breathlessness and vague disquiet in the chest. A heart attack is classically a constricting pressure in the chest, often with a feeling of impending doom and shortness of breath. However, a heart attack can present as stomach pain, neck or jaw discomfort, back pain, shoulder or left arm discomfort, just shortness of breath, and can sometimes be “silent” (without symptoms).
The sensation of a “pounding heart” would be very unusual for a heart attack. Heart rhythm disturbances (an irregular or rapid heart rate) can cause this symptom but it could also be from an adrenalin rush from being startled by a phone ringing in the night, or frightened by a suddenly dangerous situation, or intense and acute anxiety. If someone has a structurally normal heart, no coronary artery disease, and no fainting or near fainting, the symptom of a pounding heart is generally benign.
Getting the symptom evaluated to rule out a cardiac cause was a smart thing to do. If your husband does have a problem with stress and anxiety, dealing with it through counseling, meditation, yoga, and/or lifestyle changes should be considered.
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