A 36 year-old female complains of sudden onset of feeling of pounding hea, apprehension and excessive sweating. She fears that she is about to die. Which of the following is the likely diagnosis?
**Core Concept**
The patient's symptoms suggest a panic attack, which is characterized by sudden onset of intense fear or discomfort, accompanied by physical symptoms such as palpitations, sweating, and trembling. Panic attacks are a hallmark feature of panic disorder, a common anxiety disorder.
**Why the Correct Answer is Right**
The patient's symptoms of pounding heart, apprehension, and excessive sweating are indicative of a panic attack. Panic attacks are thought to be triggered by a combination of genetic, environmental, and neurobiological factors. The hypothalamic-pituitary-adrenal (HPA) axis plays a crucial role in the pathophysiology of panic disorder. The HPA axis regulates the body's response to stress, and abnormalities in this axis have been implicated in the development of panic disorder.
**Why Each Wrong Option is Incorrect**
**Option A:** This is incorrect because the patient's symptoms do not suggest a myocardial infarction (MI). While the patient complains of a pounding heart, this is a subjective experience and not a specific symptom of MI.
**Option B:** This is incorrect because the patient's symptoms do not suggest a hypoglycemic episode. While the patient experiences sweating, this is a nonspecific symptom that can occur in a variety of conditions, including panic attacks.
**Option C:** This is incorrect because the patient's symptoms do not suggest a psychotic episode. While the patient reports a fear of dying, this is a delusional thought that is not characteristic of a psychotic episode.
**Clinical Pearl / High-Yield Fact**
Panic attacks are a common feature of panic disorder, and can be triggered by a variety of factors, including genetic predisposition, environmental stressors, and neurobiological abnormalities. The HPA axis plays a crucial role in the pathophysiology of panic disorder.
**Correct Answer:** C. Panic disorder is the likely diagnosis.