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Panic attack or heart attack: how to tell

A panic attack feels exactly like dying: racing heart, chest tightness, shortness of breath, tingling hands. The catch is that a heart attack can feel the same, and no one — including doctors — can reliably tell them apart without an ECG. So the rule is: if it is the first time, get the ECG.

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What to do right now

Sit down and slow the breathing
Inhale for 4 seconds, exhale for 6–8. A long exhale is the fastest way to calm the nervous system.
Ground yourself
Name five things you see, four you can touch, three you hear. It sounds trivial; it works.
Remember the timing
A panic attack peaks in 10 minutes and fades within 20–30. Cardiac pain does not fade and often grows.
Check what changes the pain
Pain that changes with breathing, movement or pressing on the chest is usually not cardiac. Pain identical in every position is a reason for an ECG.
If it is the first episode — get an ECG
One examination removes months of anxiety; and if it is cardiac, it saves the heart muscle.

Call an ambulance if

First episode of chest pain or palpitations
Pain lasting longer than 20 minutes or increasing
Fainting, blue lips, oxygen saturation below 94 %
Palpitations with irregular pulse, especially in someone over 45
Attack in a person with known heart disease, diabetes or high blood pressure
Chest pain after a long flight, surgery or prolonged bed rest

What not to do

Do not take a sedative before an ECG if this is the first episode
Do not breathe into a paper bag — an outdated method that is dangerous if the cause is not panic
Do not diagnose yourself from the internet during the attack
Do not drink alcohol or coffee to calm down

What the crew does

ECG in 12 leads with immediate interpretation, troponin test if required
Oxygen saturation, blood pressure, blood sugar
Sedation once a cardiac cause is excluded
Advice on what to do next: a cardiologist, a psychotherapist or both

This page is for information and does not replace a medical examination. If the condition worsens, call the crew: +7 (985) 887-82-52.

This page in Russian: Russian version.

Questions

How much does a call-out with an ECG cost in Moscow?

Call-out 6,000 ₽ inside the MKAD, ECG 8,000 ₽, interpretation 2,000 ₽ — 16,000 ₽ in total.

Can panic attacks be cured?

Yes — cognitive behavioural therapy and, if needed, medication prescribed by a psychiatrist. Ambulance crews stop the attack; they do not treat the disorder.

I have had attacks for years — do I need an ECG every time?

No. If the pattern is familiar and unchanged, use your breathing technique. Any new symptom — different pain, fainting, irregular pulse — deserves an ECG.