Baby 20 year old female complains of sudden onset palpitation and apprehension. She is sweating for last 10 minutes and fears of impending death. Diagnosis is
## **Core Concept**
The question describes a clinical scenario suggestive of a **panic attack**, which is a discrete period of intense fear or discomfort that peaks within minutes and includes symptoms such as palpitations, sweating, trembling, feelings of choking, and fear of losing control or dying. Panic attacks can occur in various anxiety disorders, including panic disorder.
## **Why the Correct Answer is Right**
The correct answer, **Panic Attack**, is appropriate because the symptoms described—sudden onset palpitations, apprehension, sweating, and fear of impending death—align with the diagnostic criteria for a panic attack. These episodes are characterized by a rapid onset of severe symptoms that reach a peak within minutes and include physical symptoms like palpitations and sweating, alongside intense fear or anxiety.
## **Why Each Wrong Option is Incorrect**
- **Option A:** While **Hyperthyroidism** can cause symptoms like palpitations, sweating, and anxiety, it does not typically present with acute onset of such a specific constellation of symptoms (like fear of impending death) in the absence of other suggestive signs such as weight loss, exophthalmos, or goiter.
- **Option B:** **Anxiety Disorder** is a broader category that includes panic disorder but is not as specific as a panic attack for describing the acute episode detailed in the scenario.
- **Option D:** **Acute Coronary Syndrome (ACS)**, such as a myocardial infarction, could present with sudden onset of symptoms like palpitations and sweating. However, fear of impending death in ACS is more related to chest pain or discomfort, which is not mentioned in the scenario.
## **Clinical Pearl / High-Yield Fact**
A key clinical pearl is to distinguish between a **panic attack** and a **myocardial infarction (MI)**, as both can present with chest discomfort (or absence of it) and fear of death. In younger patients without risk factors, a panic attack is more likely, but ACS should always be ruled out, especially in those with cardiovascular risk factors.
## **Correct Answer:** D. Panic Attack