How do you know if it's anxiety or heart attack?

Exams and tests: Through a good relationship with a physician, that would include an exam-history and physical, and some testing that may include an ekg and even possible lab work, it would be easy to determine anxiety/panic attacks causing chest pain vs a true cardiac cause. Then once properly diagnosed and treated, the issue would hopefully be better controlled in the future. Best wishes.

FH, high lipids, HTN: At your age group the incidence of heart attack is low unless you have markers of high risk (such as familial hyperlipidemia, htn, strong family history of coronary disease at early age etc..). Presentation, history and features of the chest pain are also helpful points..