8 Conditions That Can Be Mistaken for a Heart Attack or Heart Failure
Chest pain and shortness of breath don’t always mean heart problems.
Chest pain and shortness of breath are two symptoms that grab your attention quickly, potentially signaling a heart attack if they come on suddenly. And if they develop gradually and worsen over time, these symptoms can indicate heart failure, a chronic condition in which the heart can’t pump enough blood to meet the body’s needs. However, these symptoms don’t always indicate heart troubles.
“Not all chest pain or shortness of breath is caused by the heart, but the heart is often the first thing we worry about because it’s the most vital,” says Eman Hamad, MD, director of the Advanced Heart Failure and Transplant Program at Temple University Hospital in Philadelphia. “Many conditions, from anxiety to acid reflux to muscle strain, can mimic heart disease symptoms.”
1. Heartburn
Chest pain that burns or radiates often stems from heartburn or gastroesophageal reflux disease (GERD), the medical term for chronic heartburn. “That’s one thing we commonly see in the [emergency room], patients mistaking GERD for a heart attack,” says Carey Kimmelstiel, MD, director of Tufts Medicine Interventional Cardiology Center in Boston.
Sometimes there are ways to tell the difference at home. If you have a history of GERD, your symptoms likely come on when you’re resting. Or you might lack other heart attack symptoms like shortness of breath or sweating, says Dr. Kimmelstiel. In such cases, you wouldn’t need to go to the ER, he says.
Unfortunately, these differences aren’t always reliable indicators, especially for women, who are more likely to experience atypical heart attack symptoms like heartburn or indigestion shortly before a heart attack. “When in doubt, it’s safest to get evaluated,” says Dr. Hamad.
2. Anxiety and Panic Attacks
Both anxiety and panic attacks are common causes of chest tightness, racing heart, and shortness of breath, which can feel a lot like a heart attack. Panic attacks also tend to come on suddenly, making you feel dizzy, tingly, and an impending sense of doom.
Neither anxiety nor panic attacks are caused by heart problems, and even the heart palpitations that hit during a panic attack aren’t actually dangerous to your heart, says Kimmelstiel. Chest symptoms caused by anxiety or panic attacks aren’t tied to physical exertion, while heart attack symptoms get worse with activity. Panic attack symptoms also tend to subside within an hour, but heart attack symptoms don’t let up.
On the other hand, it’s possible to have anxiety and coexisting cardiac issues simultaneously. “That’s why it’s critical not to assume your symptoms are just [caused by] stress,” says Hamad. “Evaluation is the only way to be sure.”
3. Muscle Pain
Sudden, sharp discomfort around your chest, shoulders, or upper back could be caused by an injury like a pulled chest muscle or bruised or broken ribs. That’s especially true if it seems like the pain was triggered by a specific activity (like lifting a heavy box) and the pain flares up when you try to do the activity again, or if the area feels tender when you press on it, says Kimmelstiel.
You may be dealing with an injury instead of a heart attack if the pain eases up after a few minutes, improves or worsens when you change positions, or is localized to one small area rather than radiating to other parts of your upper body like your neck, jaw, or arms.
Again, get the problem checked out if you have any doubts, especially if you have heart disease risk factors, says Hamad.
4. Shingles
Chest muscle pain can also result from shingles, a viral infection caused by varicella-zoster, the same virus that causes chickenpox. Hamad says it’s particularly common before a rash appears near the chest.
Shingles pain tends to feel deep, burning, or shooting. You might also have itching or tingling around the affected area, which may also include your face, neck, stomach, or back. The infection causes flu-like symptoms as well, such as fever, chills, headache, and even stomach discomfort.
Let your doctor know if you think you have shingles. Treatments like antiviral medications and corticosteroids can help you recover faster and potentially avoid serious complications.
5. Heart Inflammation
Sometimes an upper respiratory infection can cause the heart to become inflamed temporarily. When the inflammation affects the lining of the heart, it’s called pericarditis. When it affects the heart muscle itself, it’s called myocarditis. “It can be very common in young people,” says Kimmelstiel. “We saw a lot of it during [the] COVID-19 [pandemic].”
Both pericarditis and myocarditis can cause heart attack-like symptoms, including chest pain and shortness of breath. Chest pain caused by pericarditis tends to get better when you sit up and lean forward. Myocarditis can also cause leg or foot swelling, heart palpitations, and fatigue.
Sometimes these symptoms are mild and go away on their own. Other times, without treatment, they can be severe enough to cause long-term complications like blood clots or heart failure, so it’s important to get checked out quickly.
6. Thyroid Issues
Both an overactive thyroid (hyperthyroidism) and an underactive thyroid (hypothyroidism) can cause symptoms that mimic heart disease, largely due to the fact that the thyroid plays a key role in helping the heart maintain a normal rhythm.
If your thyroid is overactive, you might experience a racing heart, shortness of breath, or fatigue, all of which can resemble arrhythmia or even heart failure, says Hamad. An underactive thyroid, on the other hand, can lead to fluid retention and a slow heart rate (bradycardia), which is sometimes mistaken for cardiac dysfunction, she says.
Your healthcare provider can figure out if a thyroid issue is driving your heart symptoms with a simple blood test, indicating whether your thyroid is making too much or too little thyroid hormone.
7. Lung Conditions Like COPD
Shortness of breath and chest tightness or discomfort are common features of many different breathing problems. These symptoms can come on suddenly from conditions like pulmonary embolism, pneumonia, or pneumothorax (air between the lung and the chest wall) and are sometimes indistinguishable from a heart attack, says Hamad.
Other lung problems, like chronic obstructive pulmonary disease (COPD), can cause breathing and chest symptoms that slowly worsen over time. Think trouble catching your breath, frequent coughing, chest heaviness, fatigue, and swelling in your lower extremities, many of which can look similar to heart failure.
Lung problems differ from heart attacks or heart failure, but they’re still serious. So if you’re having symptoms, seek prompt medical care to figure out exactly what’s going on and how to treat it.
8. Kidney Disease and Liver Disease
Kidney disease and liver disease can sometimes look similar to heart failure. “Because the heart, lungs, kidneys, and liver work together to regulate fluid, oxygen, and metabolism, symptoms often overlap,” says Hamad.
Both kidney disease and heart failure, for instance, can cause shortness of breath caused by fluid overload. And like heart failure, liver disease can cause chest discomfort, fatigue, and swelling, says Hamad.
If you have any of these ongoing symptoms, make an appointment to see your doctor. They can run tests to determine the root cause and decide on an appropriate treatment plan for you.
When to See a Doctor
Seek medical attention any time you have concerning chest symptoms. While some symptoms warrant a trip to the emergency room, others can wait to be addressed at your doctor’s office.
According to Hamad, you should call your doctor for:
Chest discomfort that’s mild, brief, or clearly related to movement
Ongoing fatigue, palpitations, or swelling that doesn’t improve
Family history of heart disease or new, vague symptoms
She recommends heading straight to the emergency room for symptoms of a possible heart attack, including:
Chest pain or pressure that lasts for more than a few minutes
Pain radiating to the arm, jaw, or back
Shortness of breath
Nausea, sweating, or lightheadedness
Irregular or very fast heartbeat
The Takeaway
A number of health conditions can mimic heart attack and heart disease symptoms such as chest pain and shortness of breath.
Heartburn, anxiety, and pulled muscles in or near the chest may present similarly to a heart attack, but they can typically be evaluated and treated safely at your doctor’s office rather than requiring a trip to the emergency room.
Some infections, thyroid issues, lung conditions, kidney disease, and liver disease can also have symptoms that mimic heart disease and should be evaluated and treated promptly to avoid complications.
While you may not be experiencing a heart attack, it’s important to seek medical attention any time you have concerning chest symptoms.
