The false heart attack: when panic attacks mimic medical issues

For many people, a panic attack can start with a sense of tightness in the chest. Your heart might start to race, your palms may start sweating, and a sense of dread washes over you. In that moment, the brain might be screaming one single terrifying thought: What if I am having a heart attack? 

Every year, many people rush to A&E and emergency rooms around the world convinced they are having a cardiac event, only to discover that their heart is healthy. I see this frequently while working in the NHS. Often, people are told they are anxious and that they might have had a panic attack.

Severe anxiety can sometimes cause physical symptoms that mimic medical emergencies. Understanding why these symptoms can overlap may help you make sense of what you're experiencing, particularly if panic attacks become chronic.

Why do panic attacks feel so physical?

Many of you may have heard about the mind-body connection, but nothing can really prepare you for that internal fire alarm going off, as it can happen suddenly. One minute you may be doing a simple task such as walking, sitting at your desk, watching TV, or driving home, and then suddenly panic might switch on for no reason, which can be why it feels so frightening.

Our bodies have a built-in alarm system called the fight-or-flight response, designed to protect us in dangerous situations. When we face an actual threat, our brains flood the body with stress hormones to help us fight or run away, which, from an evolutionary perspective, has helped us survive.

During a panic attack, this system can sometimes misfire. It can trigger a huge surge of stress hormones such as adrenaline, sometimes for no reason at all.

Exploring the copycat symptoms

The adrenaline and stress hormones that can flood our bodies during a panic attack can cause physical symptoms that overlap with those experienced during a cardiac event.

For example:

Racing heart

Adrenaline forces the heart to pump faster to get blood into the muscles. This can feel like palpitations or an irregular rhythm. 

Chest pains and tightness

The chest muscles can freeze and contract, and many people begin to hyperventilate, taking short, shallow breaths. This overinflation of the lungs strains the chest wall, which can then cause chest pain.

Air shortages

Hyperventilation changes the balance of carbon dioxide in the blood. Paradoxically, this can make it feel like it's hard to breathe, possibly leading to a choking sensation for some people.

Dizziness and tingling

Changes in carbon dioxide levels in the blood can cause blood vessels in the brain to narrow slightly, which may contribute to dizziness and tingling or numbness in the fingers.

If you are experiencing chest pain and it feels severe, seek support from emergency services and get advice from a medical professional to rule out a cardiac event.

Long-term effects of the false alarm

When these types of episodes start to become frequent, and medical emergencies have been ruled out but you are often finding yourself going to the doctor or to A&E regularly, they can start to create a loop of medical anxiety.

Your mind might slip into hypervigilance, fear, and ongoing symptom scanning, and you might notice you are monitoring your body often, scanning for signs that something is off. You might find yourself checking your pulse, over-analysing every twinge or sensation in the chest, avoiding exercise and stressful situations out of worry.

This could be keeping the nervous system in a state of low-level fight-or-flight mode, which might make you more likely to have another 'misfire'.

Rewiring that misfire using cognitive behavioural hypnotherapy (CBH)

Because panic often involves both catastrophic thinking and a severe physical reaction (such as a racing heart), treating it requires looking at both the mind and body. CBH can be effective for some people here, as it combines practical elements of CBT with hypnosis that can help retrain your mind and body, helping to dismantle the panic cycle gradually.

If you work with a CBH practitioner, they will likely guide you through some of the following techniques:

Mapping out the cycle and cognitive restructuring

In panic, the mind can make catastrophic misinterpretations (eg chest tightness = heart attack) about your symptoms. A therapist can help you 'map' this out, including identifying the cycle that you are stuck in, and then challenge these thoughts both through talk therapy and in hypnosis.

Because the critical and analytical mind is often slower in hypnosis, it is thought that the mind is more likely to accept a safer and less anxiety-inducing alternative, such as: "This is just my adrenaline firing, my heart is healthy, and this will pass."

Hypnotic interoceptive exposures

A major driver of chronic panic is also the fear of physical sensations themselves. A therapist could support you to trigger the sensations that are uncomfortable in and out of hypnosis. This is known as interoceptive exposure.

In hypnosis, you may be guided to imagine a symptom, like your heart beating faster, while remaining in a state of calm. This pairs the triggers, such as a racing heart, with a new response, such as being calm, effectively breaking that automatic loop that you are stuck in. 

Somatic desensitisation and anchoring

CBH can utilise muscular relaxation tools and breathing training both through the use of talk therapy and hypnosis. The therapist will often anchor this state of physical safety to a simple cue, such as pressing your thumb and forefinger together, or repeating a specific word. When panic then comes over you, triggering this anchor can help ground the body with a calm response.

Mindful acceptance and flow

Instead of fighting that attack, which increases adrenaline, CBH can help you mindfully observe the sensations without judging them as dangerous. Under hypnosis, you can rehearse riding that wave of panic, treating it like a passing storm rather than something that's dangerous, which can help drop that adrenaline spike quicker.

Psychoeducation and learning

Additionally, you will learn about anxiety, how it works and why it happens. This can reinforce the above and help you shift those powerful thoughts and beliefs.

You don't have to live at the mercy of an alarm that isn't serving you. By combining CBT strategies with the deep-level retraining hypnosis can offer, you can provide your mind and body with a new script to follow, one that allows you to feel calmer, quiet your mind and reclaim some control.

Browse the directory for CBH practitioners today to get support if you're stuck in this exhausting, repetitive cycle.