How do I know I'm just having a panic attack and not a heart attack?
Sanjay Gupta: So you can never absolutely know, but I can give you tips on what I think when I see someone and how I work out whether ... by far, things go wrong for four reasons and those are the four things I look at.
Age, so if I see someone who is 20, who is complaining of palpitations or chest discomfort, I automatically think it's not likely to be a heart attack. Heart attacks are largely a disease of older people, but if someone were 80 and they complained of chest discomfort, then that would be the first thing that would go through my mind.
Could it be the heart? 20, it would be the last thing on my mind. So who you are, your age is really important.
And the second thing is your genetics are really important. Now if you were someone who comes from a background where your family, every member of your family has dropped down dead of a heart attack at the age of 25, then I would take that a lot more seriously, but if you're otherwise well and there's no family history of any issues, then that makes it very unlikely.
And the third thing I guess is lifestyle. I look at the patient's lifestyle and if someone was a heavy smoker, who is very overweight, who has diabetes, who has high blood pressure, then that makes it a lot more likely.
If on the other hand, there are otherwise well, they play football every day, they're thin, then that makes it very unlikely that they're having a heart attack. It's always a good idea to get checked out if you have these symptoms, largely for reassurance if you're otherwise young and otherwise healthy.
The other thing I would say is that most people who have heart attacks,
Sanjay Gupta: When you have a heart attack, it is almost like an elephant sitting on your chest, that is the sensation you get. It is not a pounding in the chest, boom, boom, boom, that's not what heart attack ... people will say, I feel like there's an elephant sitting on my chest, it feels raw and feels sore and I feel clammy and they feel nauseous.
Nauseous is a really big feature and it's almost a feeling of impending doom, they feel like something is really wrong here. And they go gray, so I can go into a casualty department and
I can tell who's having a heart attack just by their color, they actually go gray. Whereas people who have panic attacks, the symptoms are very dramatic. Boom, boom, boom, your hands are going ... you start developing tingling and pins and needles and you automatically think, pins and needles equals heart attack.
But no, I think it's who you are by far. Your age, your risk factors, your family history, and then secondly the nature of the discomfort is very important.
People who panic will complain of pounding, they'll complain of stabbing pains or a vibration like pain, they complain of localized pain on one, side whereas people who are having heart attacks will complain of almost like being squeezed or crushed or something sitting on their chest.
Barry McDonagh: That's good to know because generally what comes up the most is that pounding heart or maybe it's the skipped heartbeats, all of that, but it's the heightened activity of the heart that's really scaring a lot of people who are in the fight-or-flight response.
Sanjay Gupta: That is very rarely ever the cause of ... that is very rarely ever the presentation of a heart attack, it is always a real discomfort or a heaviness.