Hyperventilation, Panic Attack or Medical Emergency? How to Tell and When to Call 911

Urgent first

If you are not sure, treat it as an emergency. MedlinePlus says that if you are having symptoms of a heart attack you should call 911 "even if you are not sure it is a heart attack." [1] In the US, call 911 for chest pain or pressure, severe difficulty breathing, blue or grey lips or skin, sudden confusion, or fainting that does not clear quickly. [1][2][3] If you or someone you know is having thoughts of suicide, call or text 988, the Suicide & Crisis Lifeline. [4] In the UK, the NHS lists 999 for these situations. [5]

You cannot reliably tell these conditions apart from the inside, and this page does not teach you to. A clinician decides.

Why they get mixed up

The three situations share symptoms. NIMH says panic attacks often include physical symptoms that might feel like a heart attack, such as trembling or tingling or a rapid heart rate. [4] The NHS lists chest pain, shortness of breath, dizziness and tingling among panic attack symptoms, and says most of these can also be symptoms of other conditions, so you may not always be having a panic attack. [6] MedlinePlus lists chest pain, a pounding heartbeat, dizziness and tingling among the symptoms of overbreathing, and lists heart attack and lung disease among its causes. [7]

Sources for the table: [7][6][1]. The table shows overlap, not a way to sort yourself.

Panic attacks: what the sources say

The NHS says most panic attacks last between 5 and 20 minutes and that, although frightening, they are not dangerous and will not cause physical harm. [6] NIMH says they are not life-threatening and the physical symptoms usually resolve with time, though for some people fear of future attacks leads to ongoing anxiety. [4] Those statements apply once a clinician has established that it is a panic attack, not before.

Overbreathing

Overbreathing can be part of a panic attack or can have medical causes such as bleeding, heart failure, infection or diabetes-related ketoacidosis. [7] See overbreathing and hyperventilation. MedlinePlus says rapid breathing for the first time may be a medical emergency. [7]

Heart attack and other emergencies

MedlinePlus lists chest discomfort, shortness of breath (sometimes the only symptom) and discomfort in the arms, back, neck, jaw or upper stomach among heart attack symptoms. [1] The NHS adds that the pain may feel like crushing or squeezing and spread to the arm, neck and jaw. [5] The NHS says not to try to self-diagnose the cause of shortness of breath and to see a GP. [2]

What to do after a first episode

Whatever the cause turns out to be, a first episode needs a medical check. The NHS says a GP may do a physical examination to rule out other conditions. [6] NIMH says a provider may do the same to ensure an unrelated physical problem is not causing the symptoms. [4]

Treatment for panic disorder

Talking therapies and medicine are the main treatments, according to the NHS. [6] NIMH says cognitive behavioral therapy is commonly used and that exposure therapy may be used along with relaxation exercises and breathing training techniques. [4] Both describe breathing as part of a wider plan, not a stand-alone cure. For what trials found, see breathing exercises for panic attacks and panic disorder and the goal page on panic attacks.

During a panic episode a clinician has already identified

The NHS suggests staying where you are if possible, breathing slowly, and reminding yourself that the attack will pass. [6] If you feel lightheaded or tingly when focusing on your breath, stop and breathe normally. See dizziness, tingling and fainting during breathing exercises.