Atrial fibrillation or a panic attack - that's how you know

Atrial fibrillation, or AFib, is one of the most common types of heart rhythm disorders. Normally, the heart rhythm is controlled by electrical impulses from the sinus node. In atrial fibrillation, the sinus node no longer controls the rhythm of the atria, and the electrical activity in the atria becomes irregular and uncoordinated. This results in an irregular heart rhythm and can increase the risk of complications such as blood clots and stroke. For some people, atrial fibrillation causes only vague discomfort, while others experience clear symptoms such as:

• Heart palpitations (fast, irregular pulse)
• Chest pain or pressure
• Dizziness or feeling faint
• Fatigue
• Shortness of breath
• Exercise intolerance
• Low blood pressure

It is entirely possible and relatively common to have atrial fibrillation without experiencing any symptoms at all – it can be discovered by chance during an ECG examination. However, for some, the symptoms arouse strong anxiety, which in itself can trigger a panic attack and the difference between these conditions can be very similar.

What is a panic attack?

A panic attack is an intense episode of sudden fear or anxiety that often occurs without a clear trigger. It is a reaction from the emotional center of the brain, not a heart problem. However, the symptoms can be just as physically noticeable:

• Heart palpitations
• Trouble breathing or a feeling of suffocation
• Sweating and trembling
• Nausea
• Chest pain or pressure
• Pincerations or numbness
• Feeling of losing control or being disconnected from reality

The similarities between atrial fibrillation and panic attacks are confusing

Since panic attacks can also cause heart palpitations and chest pain, it is easy to mistake something wrong with the heart – or, conversely, to misinterpret atrial fibrillation as anxiety.

The differences in brief

SymptomsAtrial fibrillationPanic attackHeart palpitationsIrregular, often fastFast but often regularChest painCommon, pressure feelingCommon, but more stabbingShortness of breathYesYesFear/AnxietyNot alwaysAlmost alwaysDizzinessYesYesTriggersOften physical strain or illnessOften stress, trauma, anxietyDurationCan last for hours or daysOften 5–30 minutesResponse to deep breathingUnchangedUsually improves

Can one trigger the other?

There is no clear evidence that atrial fibrillation directly causes panic attacks – but frightening symptoms can of course lead to anxiety. Similarly, prolonged anxiety can affect the heart's nerve signals and possibly increase the risk of arrhythmias.

How do I know if I have atrial fibrillation?

The only way to confirm atrial fibrillation is to undergo a heart examination, mainly an ECG. If you suspect you should always seek medical attention – especially if you:

• Have recurrent heart palpitations without a clear cause
• Have shortness of breath or chest pain
• Fainting or feeling close to fainting

Treatment – ​​different approaches for different conditions

Atrial fibrillation

• Diagnosis: ECG, sometimes long-term recording (Holter ECG)
• Treatment:

  • Medications (beta blockers, antiarrhythmics)

  • Lifestyle changes (reduced alcohol intake, weight control, smoking cessation)
  • Interventions: cardioversion, ablation, pacemaker

Panic attacks

• Diagnosis: Determined via psychiatric assessment according to DSM-5
• Treatment:

  • Cognitive behavioral therapy (CBT)

  • Anti-anxiety and antidepressant medications
  • Stress management, breathing exercises and relaxation techniques