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A 28-year-old female presents to your clinic with complaints of episodic chest pain and palpitations for the last 2 months. The episodes can occur at rest or while she is walking. They are characterized by nonradiating chest discomfort, shortness of breath, dizziness, diaphoresis, and numbness in the hands bilaterally. The episodes last 5 to 15 min and are accompanied by feelings of dread. They typically occur once or twice a day. Past medical history is unremarkable. She is on no medications. She works as a paralegal. The patient is married but has been separated for 6 months. She has no children. She denies tobacco or illicit drug use and drinks two mixed drinks a day. The patient denies withdrawal symptoms and feelings of guilt or anger related to drinking. The examination is notable for stable vital signs, no jugular venous distention, normal heart sounds, and clear lungs. There is no edema. What is the most likely diagnosis?
A. Hyperthyroidism
B. Hypoglycemia
C. Panic disorder
D. Paroxysmal atrial tachycardia
E. Pheochromocytoma
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The answer is C.
Panic disorder is defined by the presence of recurrent and unpredictable panic attacks. Panic attacks are episodes of intense fear and discomfort associated with a variety of symptoms. These patients may complain of chest pain, shortness of breath, palpitations, sweating, trembling, dizziness, paresthesias, gastrointestinal distress, and feelings of doom. The attacks continue for at least a month and may cause a change in behavior in response to them. Panic disorder occurs in up to 3% of individuals over the course of a lifetime. The symptoms arise suddenly and may last from a few minutes to an hour. With progressive concern about recurrent attacks, these patients may fear going to places where they may feel trapped; this is known as agoraphobia. The differential diagnosis includes a variety of medical conditions. Cardiac causes include arrhythmias. Other considerations include thyrotoxicosis, hypoglycemia, pheochromocytoma, and mitral valve prolapse. This patient's age and normal physical examination make panic disorder the overwhelmingly most likely diagnosis. Treatment is centered on antidepressant therapy, including tricyclic antidepressants and selective serotonin reuptake inhibitors. Benzodiazepines may be useful in the initial course of treatment, but patients must be monitored closely for dependence.
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yeah....i should see the PANIC pnemonic
