Q: Although I am only 25, two episodes during the last month convinced me I was having a heart attack. Each started suddenly with shortness of breath and dizziness; heart palpitations, chest pain and sweating soon followed. During the last attack I went to an emergency room where the doctors assured me it was not a heart attack but did not tell me what was wrong. Can you explain these episodes?
A: It is hard to be certain, but it sounds as though you are having panic attacks. Your symptoms are typical of such attacks, and they generally begin before the age of 30.
Attacks are characterized by 5 to 30 minutes of intense dread along with a number of physical symptoms, some of which do mimic a heart attack: difficulty breathing, a pounding, rapid heart beat, chest pain, a choking sensation, sweating, headache, dizziness, blurred vision, nausea and numbness or tingling of the hands and feet. During an attack victims often are afraid they will faint or even die.
More often than not, panic attacks are neither properly diagnosed nor treated. One study found that a panic attack had occurred in 3 percent of the population within the prior six months and 10 percent of people had a panic attack at some time.
Estimates suggest that only one out of four people with panic attacks receive appropriate care. And it is important to establish the right diagnosis and to get proper care. When severe attacks occur often over a short period of time, they can become disabling by creating such fear of the next attack that sufferers begin to avoid an increasing number of places and situations (a condition called agoraphobia) in hopes of preventing another attack. This fear concerning future attacks and the accompanying agoraphobia has been termed panic disorder. The risk of suicide and major depression are greatly increased in people with panic disorder.
A combination of drugs and psychotherapy are often effective in treating panic disorder.
Dr. Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine and associate dean for faculty affairs at the school.