Heart Attack or Panic Attack?

Everyone has some kind of fear in their life and many of them happen to be health related. What if the person has a fear that he is going to die soon? It is difficult to imagine a life of such person who lives in the fear of death every day!

Contributed by: Dr. Bharti T Khalatia (Psychiatrist)

I came across such a patient 3 months back. 29-year-old Mr. Manish Singhla (not his real name) came to OPD with complaints of chest pain, feeling choked, and shortness of breath. He was sweating and trembling. He said, “Doctor I am having a heart attack and I am dying, please save me.” He revealed that he had similar symptoms several times since 2 years which become severe within 10 minutes and subside within 20 to 30 minutes. He has stopped going outside his home alone due to fear of these attacks. Moreover, the patient left his job due to fear that he will get the attack in office and may not get immediate help. He has stopped spending time with his family and friends. He was admitted numerous times in the hospital’s emergency department and discharged after investigations came out to be normal. All this not only led to huge hospital bills but also embarrassment among his family members that he is dramatizing his illness as investigations used to be normal. He had got so tired of such attacks that he wished it’s better to have a major attack which kills him in one go rather than suffering from fear daily.

The organicity was ruled out by necessary investigations. Once it was confirmed that he is having panic disorder, he was managed with pharmacotherapy and psychotherapy after discussing his case with the panel on bestdoctor.com (Ask a Cardiologist Online). He has started with Paroxetine 12.5 mg twice a day and Clonazepam 0.25 mg twice a day on having similar symptoms. He was also started with CBT ( CognitiveBehavior Therapy) which helped him counter anxious beliefs, exposure to fear cues, changing anxiety maintaining behavior and preventing relapse. He was given CBT twice weekly for 2 months. He was also started on Exposure therapy where he was exposed to the physical sensations of panic in a safe and controlled environment giving him an opportunity to learn healthier ways of coping by hyperventilation and holding breath exercises. With each exposure, he became less afraid of these internal bodily sensations and a greater sense of control over his panic. The patient reported 90% improvement within 21 days.

In his last visit, he reported almost 100% improvement and he was asked to continue Paroxetine 12.5 mg at night only. He has joined his job back and is now able to spend time with his family and friends.

So, all attacks may not be heart attacks and may be panic attacks which require proper consultation with trained professionals/Psychiatrists.

Dr. Bharti Kalathia

Dr. Bharti Kalathia (MBBS, DPM, FAGE, MIPS) is a Psychiatrist practising in Indore, India.