Sanjay is a 35-yr. old male a computer engineer. Few days back he had
sudden onset of palpitations, choking sensation, chest pain &
sweating. He became very anxious & now worries that he has a heart
problem (his 60 years old uncle also has similar problem). He has gone
to many cardiologists since then. His E.C.G (Electrocardiogram) has been
done & the cardiologist says that every thing is Normal, and, "come
again if you have similar attack."
Sanjays life has changed since then. Hes not the same
dynamic computer engineer. He is not going on out station projects
because he fears that if he has similar attack again in other place what
will he do. He has stopped going for picnic & badminton because he
feels his heart cannot take the load.
The worst thing is that he cannot detect & pinpoint his problem.
What is he suffering from?
Sanjay is not suffering from A heart attack but a Panic attack -
What is a Panic attack?
Panic attack is a sudden onset of apprehensions (anxiety) which can
But doctor, I am not anxious at all, I have no problems, my
life is going very smooth, what is the cause?
- chest pain/ discomfort
- choking sensation/ breathlessness
- nausea/ vomiting
- fainting / syncope/ feeling dizzy
- Feeling of impending doom, as if something is going to happen.
The cause of a Panic Attack is a sudden release of chemicals
known as Adrenaline and Noradrenaline
in our blood stream,
because of more active Sympathetic Nervous System. The Sympathetic
Nervous system has a lot of nerves going to the heart as well, so a
sudden overactivity of this system leads to excitation of the Heart and
manifests as palpitations & chest pain.
Genetic predisposition could also be a cause.
Psychological factors may not be very obvious but can be covert cause
How can I differentiate between a Heart Attack and a Panic
What should I do? Should I forget about it thinking that
was just a panic attack?
- In a Panic Attack the Chest Pain is generalized (not localized to
left side of the chest) as in a heart attack.
- It does not get relieved with anti Angina drugs.
- A lot of other symptoms e.g. nauseating sensation & feeling
of impending doom, as if something is going to happen, are present
in a Panic Attack.
- A Normal E.C.G in the presence of an attack.
No, you need treatment for this. A tendency for Panic Attacks cannot be
wished away. You need to consult a psychiatrist for proper evaluation
A Psychiatrist? I am not mad!! Why a Psychiatrist?
Its a big myth that Psychiatrists are only for mad people.
Psychiatrists are for sad people, for anxious people and a lot of other
problems, which may not present with a psychiatric or mental symptom but
have a psychiatric basis.
Self-medication, like taking Sleeping Pills or Anti Anxiety drugs can
in fact be harmful. Ignoring the symptoms can also lead to difficult
What is the treatment of Panic Attack? Just antianxiety Drugs?
No, Antianxiety drugs are one of the treatments. To decrease the levels
of Adrenaline, Noradrenaline & hyper stimulation of nerves of the
Heart other drug are also available.
Antidepressants also have an important role to play but they have to be
taken under supervision of a psychiatrist
Are these drugs Sedative and/or Addictive? If a Start them once
do I have to take them Always?
No, They are not sedatives; they are not addictive and need not be
taken always. Normally its a course of 8 months to 12 months,
after which the chemicals are brought back to the balance. Once there is
improvement they have to be gradually tapered by your Doctor (but a full
course of 8 12 months is necessary).
Any other methods of treatment?
- Yes, Relaxation exercises.
- Breathing exercises.
- Counseling &,