A 40-year-old lady arrives to the emergency room, concerned that she is suffering a heart attack. "I feel like I'm dying," she says, gripping her chest and breathing deeply. The temperature is 37.2 degrees Celsius (99 degrees Fahrenheit), the blood pressure is 125/86 mm Hg, the pulse is 110 beats per minute and regular, and the respirations are 18 beats per minute. On room air, the patient's pulse oximetry reads 98 percent. There are no abnormalities in the laboratory or on the ECG. Without treatment, the discomfort goes away in 10 minutes, and the patient recalls, "I was riding the bus home from work when my chest began to tighten. I'm glad my friend was nearby and able to assist me in getting to the hospital. What if she doesn't show up the next time?"

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Eductional Objective: Panic disorder is defined by repeated and unexpected panic episodes that are accompanied by a sudden rush of anxiety and unpleasant cardiopulmonary/neurologic symptoms. Agoraphobia, a frequent comorbid illness, causes patients to be anxious about and avoid circumstances in which they may feel trapped and helpless in the case of a panic attack (eg, crowds, enclosed spaces, public transportation).

A 40-Year-Old Lady Arrives to the Emergency Room, Concerned That