# Panic attack: what it is, why it feels like a heart attack and what to do > You are on the underground and suddenly your heart races, you cannot breathe and you are certain you are dying. Ten minutes later it passes. What actually happened, and what to do if it returns. *https://mypsicotest.com/en/blog/panic-attack/ · Published: 2026-09-25 · 8 min read · MyPsicoTest team* You are on the underground, an ordinary Tuesday, and suddenly your heart takes off. You cannot get enough air, your hands are sweating, the carriage starts to feel smaller, and one certainty overrides everything else: you are having a heart attack, or you are about to faint, or you are losing your mind. You get off at the next stop. Ten minutes later, sitting on a platform bench, it has passed and all that remains is exhaustion and the fright. That is a **panic attack**. It is one of the most terrifying experiences a person can have without being in any real danger, and precisely because it is lived as a threat to life, almost nobody recognises it the first time. ## What a panic attack is It is an episode of intense fear that arrives suddenly and peaks within minutes. The [UK's National Health Service](https://www.nhs.uk/conditions/panic-disorder/) describes panic as the most severe form of anxiety and notes that most attacks last **between five and twenty minutes**. It can have a clear trigger — an enclosed space, a stressful situation — or appear seemingly from nowhere, even at rest or waking someone in the middle of the night. That apparent lack of reason is what bewilders people most and frightens them most. One reassuring fact: having a single isolated attack in a lifetime is fairly common, much more so than people assume, and it does not mean having a disorder. What makes the difference is what happens afterwards, as we will see. ## What it feels like The NHS lists the symptoms in detail, and seeing the whole list is usually the first thing that reassures, because almost everyone recognises their own: - A racing heartbeat or palpitations. - Feeling faint, dizzy or unsteady. - Chest pain or tightness. - Shortness of breath or a choking sensation. - Sweating, hot flushes or chills. - Trembling, shaky limbs. - Nausea or a churning stomach. - Tingling or numbness, often in the fingers. - A dry mouth. - Feeling disconnected from your body, or as though your surroundings are not real. - Intense fear of dying, losing control or going mad. You do not need all of them. And the last point is the one that defines the episode: it is not only that the body is doing strange things, it is the **catastrophic interpretation** of what it is doing. ## Why it feels like a heart attack ### The body gears up for an emergency What happens in a panic attack is that the body's alarm system fires at full power with nothing actually there. It is the same response that would make you leap if a car came at you: the heart pumps more blood to the muscles, breathing speeds up to take in oxygen, you sweat to cool down, blood withdraws from the skin and stomach. All of that is useful for running or fighting. Sitting in a carriage with nothing to run from, it feels like the body malfunctioning. Fast breathing also shifts the balance of gases in the blood, producing exactly the tingling, dizziness and sense of unreality that frighten people most. ### The interpretation that fuels it The attack feeds on itself. You notice your heart racing, you read it as a heart attack, the fear speeds the heart up further, and that confirms the reading. It is a loop lasting seconds, which is why the rise is so steep. The NHS stresses a point worth repeating: although panic attacks are frightening, **they are not dangerous** and they cause no physical harm. ### When you should go to A&E That said, one warning is not negotiable. Many of these symptoms overlap with those of other medical problems, including cardiac ones. **If it is the first time, if the chest pain is severe or different from before, or if you have cardiovascular risk factors, get seen in A&E.** Ruling out a physical cause is not overreacting: it is what lets you stay calm the next time it happens. ## What to do during an attack What works is not intuitive, because instinct says to escape or fight whatever you are feeling. - **Remind yourself what it is.** "This is a panic attack, it is very unpleasant and it will pass in a few minutes." Naming it cuts into the catastrophic interpretation. - **Do not run if you can avoid it.** Staying where you are, uncomfortable as it is, teaches the brain that the place was not dangerous. Fleeing teaches it the opposite. - **Breathe slowly, lengthening the out-breath.** Breathe in through the nose for a count of four and out for six or eight. It does not need to be perfect; slowing the rhythm is enough. - **Anchor yourself in your senses.** Name five things you can see, four you can touch, three you can hear. It pulls attention out of the internal loop. - **Let the sensations rise.** Fighting them amplifies them. Accepting that your heart is racing and waiting for it to come down usually shortens the episode. If you are with someone having one, the most useful thing is to stay calm beside them, speak slowly and not overwhelm them with questions. ## A panic attack is not the same as panic disorder This is the distinction that matters most and the one almost never explained. A single attack is an episode. **Panic disorder** appears when attacks recur and, above all, when the fear of them coming back takes hold. The NHS describes it as living **in fear of fear**: the person starts avoiding situations just in case, and that avoidance creates more anxiety, which in turn makes another attack more likely. That is how the world gradually shrinks. First the underground goes, then shopping centres, then travel, then going out without someone trusted. When the avoidance spreads to places where escape or help seems difficult, it is called **agoraphobia**, which often accompanies panic disorder. The good news lies in the same mechanism: what keeps the problem going is avoidance, and that is exactly what treatment works on. ![Woman sitting on a bench by the river with her eyes closed, breathing calmly after a panic attack](https://mypsicotest.com/assets/img/blog-calma-despues-ataque-de-panico-1200.webp) ## When to look at it more closely A single attack needs no treatment, but it is worth paying attention when episodes recur, when you spend much of the day watching for the next one, or when you have started avoiding places or situations in case it happens there. Screening questionnaires help put a number on what lies underneath. The [Anxiety Test](https://mypsicotest.com/en/anxiety-test/) measures worry and physical arousal, the ground panic usually grows from. The [Social Anxiety Test](https://mypsicotest.com/en/social-anxiety-test/) is the right one if attacks mostly come in situations where you feel watched or judged. And the [Stress Test](https://mypsicotest.com/en/stress-test/) is useful if it all started during a period of overload. They are in the [psychological tests](https://mypsicotest.com/en/psychological-tests/) catalogue, free and anonymous, and the result is calculated on your own device. Our guide on the [Mental health test: what it measures, which ones exist and how to read your result](https://mypsicotest.com/en/blog/mental-health-test/) explains how to read those scores. [MedlinePlus](https://medlineplus.gov/panicdisorder.html) has general information on panic disorder to get your bearings. ## Which treatment works Here the clinical guidelines are clear, and it is worth knowing before accepting the first thing offered. For panic disorder, the [NICE guideline](https://www.nice.org.uk/guidance/cg113) states that **cognitive behavioural therapy** should be used, and puts its optimal duration at a total of **seven to fourteen hours**. It is a relatively short treatment for what it achieves. It works on the interpretation of bodily sensations and, above all, on graded exposure both to the situations being avoided and to the frightening sensations themselves, until they stop reading as a threat. How it works in general is covered in [Cognitive behavioural therapy: what it is, how it works and what it treats](https://mypsicotest.com/en/blog/cognitive-behavioural-therapy/). The same guideline is equally clear in the other direction: **benzodiazepines are associated with a less good outcome in the long term and should not be prescribed** for panic disorder. They stop an attack, but they consolidate the idea that something external is needed to survive one. If you already take them, do not stop on your own; the why and the how are in [Anxiety medication or therapy: what works better for anxiety](https://mypsicotest.com/en/blog/anxiety-medication-or-therapy/). And if you decide to take the step, [When to see a psychologist: signs, common doubts and what happens in the first session](https://mypsicotest.com/en/blog/when-to-see-a-psychologist/) covers what happens at that first appointment. ## Frequently asked questions ### How long does a panic attack last? Most last between five and twenty minutes, with the peak intensity early on. Tiredness or a sense of unease may linger for a while afterwards. Some episodes go on longer, but these are usually several peaks in a row rather than one continuous attack. ### Can a panic attack give me a heart attack or kill me? No. Although it feels like a threat to life, a panic attack causes no physical harm. That said, its symptoms resemble cardiac problems, so the first time, or if the chest pain is severe or different, get seen in A&E to rule out other causes. ### How do I know whether it is panic or a heart problem? From the outside it is not always possible to tell, which is why the first episode gets checked medically. As a rough guide, panic usually peaks within minutes and eases in under half an hour, and comes with intense fear and often tingling and a sense of unreality. When in doubt, always A&E. ### Why do I get panic attacks for no reason? There is almost always a reason, even if it is not obvious. They tend to appear during periods of sustained stress, when the alarm system is already overloaded, and can be set off by a tiny physical sensation that gets read as danger. Not identifying the trigger does not mean there is none. ### Is a panic attack the same as an anxiety attack? In everyday speech the terms are used interchangeably, but they are not quite the same. A panic attack is sudden, peaks within minutes and is very intense. Anxiety tends to build more gradually around a specific worry, and lasts longer at lower intensity. ### Can an online test tell me whether I have panic disorder? It does not diagnose it, but it does help place it. A screening questionnaire estimates your level of anxiety and physical arousal, the ground on which attacks occur. With that measure you arrive better prepared at an appointment, where a professional will assess whether there is panic disorder or agoraphobia.