Heart Attack or Panic Attack?

Sarah comes into the office complaining of chest pain, sweating, racing heart, and shortness of breath. She is worried about having a heart attack. Physical exam and EKG are all normal. What is the next step for Sarah who is having a panic attack?

First, of course, we treat her panic attack with a low dose sedative if necessary. She may already feel much better by the time we are done with the testing. But then, it is critical to inform Sarah about panic attacks and anxiety disorders in general.

Anxiety disorders are the most prevalent mental disorders in the population, reaching 12%-15%. The Anxiety Disorders Association of America estimates that approximately 40 million Americans suffer from an anxiety disorder, and a third of the general population experiences a panic attack during their lifetime.

Stress is a huge trigger of panic attacks, which can present as heart palpitations, muscle aches or tension, dry mouth, shortness of breath, headache, excessive sweating, dizziness, and/or lightheadedness. Therefore, it’s important to help Sarah identify potential current stressors. Most stressors are social or financial. Just being able to trace the anxiety back to its precipitants is therapeutic. Psychotherapeutic techniques can help anxious patients become aware of worry thoughts, and reevaluate and reduce the deleterious impact of such thoughts. These techniques can be taught in a limited amount of time (a few weeks) and can be of tremendous assistance. Helping Sarah to realize that she can be helped by a therapist and encouraging her to follow through would be a great therapeutic intervention.

In addition, we can mention the four general basic tips to reduce stress:
• Healthy eating and drinking. Regular, well-balanced (protein, vegetables) meals, with a minimum of caffeine and alcohol.
• Sleep. Make time for a sufficient amount of sleep. Most adults need 7 ½ to 8 hours of sleep.
• Exercise. Stress and anxiety may cause physical tension, high blood pressure, and tightness throughout the body. Exercise is a great stress reliever and reduces anxiety symptoms. Exercise is good for your mind and body. It is recommended that healthy adults, aged 18 to 65 years old, have 20 to 30 minutes of moderate intensity aerobic activity five days a week (e.g., brisk walk).
• Breathing. Deep, diaphragmatic breathing reduces anxiety and can stop panic attacks. It changes the rate of the respiration and calms down physical arousal. The advantage of this technique is not only its effectiveness, but also the fact that it can be done at any time and any place. Basic breathing instructions: become aware of the way you breathe. Breathe from your abdomen. Place a hand on your abdomen and feel the flow of air, in… , and out. Count while breathing to follow a rhythm.

As a friend or physician, if you are able to help Sarah recognize when she is anxious, understand why she is anxious, and get her interested in learning more about how to reduce her overall stress level, you’ve done a great job.