Steven Van Dyke iHuman Panic Disorder (36-year-old male with acute chest tightness)

Steven Van Dyke iHuman Panic Disorder

The patient is a 36-year-old male smoker who presents to the ED following the acute onset of nonradiating, nonreproducible chest tightness of > 20 minutes duration, symptoms beginning while he was watching TV. He complains of associated palpitations, SOB, choking sensation, dizziness, nausea, sweating, and “fear of having a heart attack.” He reports a 1-month history of similar episodes lasting 5-20 minutes, and now increasing in intensity over the past 1 week. The first episode happened while exercising; subsequent episodes occurred during work-related meetings. This is the first episode occurring at rest outside of the work context. PMH is significant only for childhood asthma; he denies any history of psychiatric disease. The patient’s father died 2 years ago at age 62 due to an MI. PE reveals an anxious-appearing young male with fidgeting of hands and legs. He is tachycardic and takes deep breaths between speaking in phrases. The cardiopulmonary and neurologic exams are otherwise normal.