- Can occur de novo or in setting of psychiatric disorder (most commonly panic disorder)
- Discrete period of intense fear or discomfort that peaks within a few minutes 'plus at least four of the following:
- May feel the "urge to flee" or "sense of impending doom"
- Other Associated with Normal/↑ Respiratory Effort
- Other Associated with ↓ Respiratory Effort
- Uncorrected ASD
- Congenital heart disease
- COPD exacerbation
- Panic attack
- Pleural effusion
- Rib fracture
- Spontaneous pneumothorax
- Thyroid Disease
- Diagnosis of exclusion: must rule out organic causes of symptoms (see chest pain, palpitations, shortness of breath, etc.)
- Clinical diagnosis, based on history and physical exam.
- Reassurance and patient education
- 1-2mg Lorazepam (Ativan) IV/IM
- Foldes-Busque G, Denis I, Poitras J, Fleet RP, Archambault P, Dionne CE. A prospective cohort study to refine and validate the Panic Screening Score for identifying panic attacks associated with unexplained chest pain in the emergency department. BMJ Open. 2013;3(10):e003877. doi:10.1136/bmjopen-2013-003877.