Thank you for asking such a fascinating question. It can be hard to tell anxiety apart from heart problems. The following pointers may be useful:
Chest pain from anxiety tends to be more localized and sharp, while heart attacks radiate and are often duller.
Panic attacks rarely cause vomiting, which may be more commonly seen in heart attacks. Third, panic attacks tend to follow a particular fixed pattern. They generally peak about 10 minutes in and then there is a slow and steady decline. Heart attacks can follow this same pattern, but it is less common.
It can be a challenging situation at the clinic as many patients have both heart/lung condition and anxiety disorder, especially if the individual is an elderly person. Anxiety can cause the heart rate to become faster and on the other hand, it is also possible for a fast heart rate to fuel anxiety. It can be a chicken and egg issue.
The following are additional clues that the doctor may find useful.
Firstly, doctors would look at the symptom pattern. If anxiety makes a person’s heart go faster, then something causes stressful feelings that are followed by an elevated heart rate. However, if the heart is causing the anxiety, then heart palpitations or a racing heart comes first, followed by anxiety. Sometimes the racing heart causes giddiness, floating sensation or chest discomfort, and anxiety escalates.
Second, whether they are passing out or having a seizure. These would imply that there could be an abnormal heart rhythm. Anxiety disorders or panic attacks rarely cause a person to pass out.
Third, any features of hyperventilating. When a person is anxious or panicking, he or she may hyperventilate, which then manifests as numbness and tingling in the tips of the fingers on both hands, and around the mouth. Usually, anxiety causes this hyperventilation. However, if the person also feels lightheaded or faint, it could be because of a drop in the blood pressure, and it will be good to exclude an abnormal heart rhythm.
Fourth, a closer look at the triggers. Abnormal heart rhythms often result from a trigger: extra heartbeats in the upper and lower heart chambers. People with abnormal heart rhythms often feel these extra beats, and suddenly their heart races as if a light switch turned on a light. In contrast, with anxiety, the heart rate increases uniformly without extra or skipped beats.
Fifth, any evidence to suggest a weakening heart. With abnormal heart rhythms like atrial fibrillation, the heart is an abnormal one. If the abnormal rhythm is left untreated, it can weaken the heart and lead to heart failure. Anxiety-related elevated heart rates do not cause the heart to weaken over time or cause swelling of the lower limbs.