Case history
Case history #1
A 22-year-old woman in her first year of college reports waking in the middle of the night with a pounding heart, hot flushes, smothering sensations, and intense nausea. The attack came suddenly and unexpectedly, was not in reaction to a nightmare, and the symptoms subsided within a few minutes. Over the last few months, she is feeling more anxious and has experienced similar episodes each week at varying levels of intensity. She is worried that she might be on the verge of a "nervous breakdown" and admits to being overly aware of her "fast breathing and heart rate".
Case history #2
A 38-year-old man presents to the emergency department for the second time in 4 weeks with sudden-onset chest pain, tachycardia, shortness of breath, dizziness, and sweating. He says he is afraid of having a heart attack and is afraid of "losing his mind". He is no longer driving his car and has started avoiding crowded areas for fear of inducing further attacks. Past medical history is unremarkable. Cardiac testing during both admissions is normal.
Other presentations
Panic attacks may also occur in the presence of medical conditions that produce uncomfortable physical sensations, such as diabetes, asthma, and hypertension.[5] Cigarette-smoking may also be common among those with a history of panic attacks, as is an elevated risk for substance misuse and substance use disorders, especially among those with more severe panic.[6] Some patients may have difficulties tolerating antidepressant medication trials secondary to overly focusing on adverse effects.
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