panic attacks

Question 1

a 24 y.o. woman presents to casualty feeling lightheaded, SOB and with tingling in her fingers. physical assessment (including ECG) is unremarkable apart from moderate tachycardia, hyperventilation and tremor. she gave a hx of several similar episodes occuring when in supermarkets or on buses. you believe she may be having a heart attack.

(a) list 4 additional sx that would support a psychological cause for her problem

Answer 1

1. globus pharyngeus (persistent sensation of having something stuck in one’s throat when there isn’t)
2. fear of dying
3. collapse
4. blackout
5. chest tightness despite no identifiable cardiac abnormality

Question 2

(b) what is the most likely underlying dx?

Answer 2

panic disorder with agoraphobia

Question 3

(c) what is the mechanism for the tingling in her fingers?

Answer 3

hyperventilation → respiratory alkalosis → paraesthesia

Question 4

(d) what simple non-pharmacological measures might you take immediately in casualty to treat the acute problem?

Answer 4

• encourage pt to breathe deeply e.g. 7 seconds in and 11 out
• challenge their negative thoughts e.g. “you’re not going to die”

Question 5

(e) give 2 drug rx which may be appropriate for short-term mx

Answer 5

1. Beta-blockers e.g. propanolol
2. SSRIs e.g. escitalopram

Question 6

(f) what psychological rx is appropriate for longer term mx?

Answer 6

anxiety rx