A 25-year-old woman rushes to an emergency depament because she is afraid she is dying. She is experiencing chest pain, a sensation of choking, nausea, and tingling sensations up and down her arms. When the screening nurse examines the patient, her face is flushed and sweating. Her pulse is 140/min and respirations are 25/min. When the emergency depament physician examines her 15 minutes later, her symptoms are dissipating; her pulse is 100/min, and respirations are 20/min. The ECG is normal, except for some residual tachycardia. Which of the following is the most likely diagnosis?
A 25-year-old woman rushes to an emergency depament because she is afraid she is dying. She is experiencing chest pain, a sensation of choking, nausea, and tingling sensations up and down her arms. When the screening nurse examines the patient, her face is flushed and sweating. Her pulse is 140/min and respirations are 25/min. When the emergency depament physician examines her 15 minutes later, her symptoms are dissipating; her pulse is 100/min, and respirations are 20/min. The ECG is normal, except for some residual tachycardia. Which of the following is the most likely diagnosis?
💡 Explanation
**Core Concept**
A panic attack is a discrete episode of intense fear or discomfort that reaches a peak within minutes, often accompanied by physical symptoms like tachycardia, palpitations, sweating, and shortness of breath. This episode is followed by a period of recovery, during which the individual returns to their baseline level of functioning.
**Why the Correct Answer is Right**
The patient's symptoms, including chest pain, choking sensation, nausea, tingling sensations, and tachycardia, are characteristic of a panic attack. The rapid onset and peak of symptoms, followed by a quick resolution, support this diagnosis. Additionally, the patient's normal ECG, despite tachycardia, suggests that there is no underlying cardiac cause for her symptoms. Panic attacks often involve a sense of impending doom or death, which fits with the patient's initial presentation.
**Why Each Wrong Option is Incorrect**
**Option A:** Angina is a condition characterized by chest pain or discomfort due to transient myocardial ischemia, often triggered by exertion. The patient's symptoms and resolution do not fit this diagnosis, as angina is typically associated with exertion and does not resolve as quickly.
**Option B:** Heartburn is a symptom of gastroesophageal reflux disease (GERD), characterized by a burning sensation in the chest and throat. The patient's symptoms do not match heartburn, and there is no indication of GERD in the scenario.
**Option C:** Myocardial infarction is a condition characterized by permanent damage to the heart muscle due to a blockage of a coronary artery. The patient's normal ECG and rapid resolution of symptoms make this diagnosis unlikely.
**Clinical Pearl / High-Yield Fact**
Panic attacks can be triggered by various factors, including stress, anxiety, and certain medications. Recognizing the characteristic symptoms of a panic attack is essential for accurate diagnosis and treatment.
✓ Correct Answer: D. Panic attack
✓ Correct Answer: D. Panic attack
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