Brief description of the case: Patient Zhang, female, 31 years old, came to the clinic with “recurrent chest tightness and panic attacks for one month”. The patient had a headache, body aches, and weakness after catching a cold one month ago, and was refused a ride by a cab driver on the way to the clinic (the driver was worried that the patient had “influenza A”). He was terrified. He went to the emergency room of the local hospital, and his blood count, electrolytes and cardiac enzyme profile were not abnormal. The electrocardiogram showed sinus tachycardia, HR: 115 beats/min, T-wave inversion. The local hospital diagnosed “viral myocarditis awaiting exclusion” and treated the patient with rehydration support. The patient was hospitalized in the local hospital for 3 days without any similar symptom attacks. On the third day after discharge, the patient again developed panic attacks, chest tightness, breathlessness, and a strong feeling of near death without any obvious cause, which peaked about 10 minutes after the onset of symptoms. The ECG showed sinus tachycardia, and no abnormality was found in the routine blood, electrolytes and cardiac enzyme profile. The patient was adamant about rehydration, and the symptoms resolved rapidly after rehydration. Thereafter, similar symptoms occurred once every 1-2 days, or even twice in one day, with each episode lasting half an hour, which rapidly resolved after the patient insisted on rehydration. In addition, he often had difficulty sleeping at night, wandering chest pain during the day, loss of appetite, and repeated fears that he had “influenza A” and that “something was going to happen to his heart”, making it difficult for him to go to work for the past 2 weeks. The patient questioned the previous diagnosis and treatment of “myocarditis” and repeatedly visited the cardiology departments of several hospitals for myocardial enzyme profile, 24-hour ambulatory electrocardiogram, and cardiac ultrasound, but no abnormalities were found. Even though the cardiologist repeatedly informed him that he had no serious organic disease, the patient could not accept it. Mental examination: clear consciousness, active contact, smooth thinking, more worried about health status, complained that “I feel like I’m going to die every time I have an attack, and when I don’t have an attack, I’m scared, I don’t know when I’ll have another attack”, expression of apprehension, emotional tension and anxiety, rapid speech, strong desire for treatment, self-knowledge exists. Diagnosis: panic disorder This is a typical case of panic disorder, and the patient’s consultation process reflects the medical seeking experience of most panic disorder patients. Most patients with panic disorder believe they have a heart attack, keep visiting the emergency room or cardiology department during panic attacks, repeatedly undergo various tests related to heart disease, and are repeatedly advised by internists before visiting the psychiatry department or psychiatric department. Clinical characteristics of panic disorder Panic disorder is the most common anxiety disorder in the emergency room of a general hospital, characterized by repeated panic attacks, with at least three or more attacks in a month, or anxiety secondary to fear of further attacks lasting for one month after the first attack. It can occur at any age, although it is most common between the ages of 20 and 40. Panic attack symptoms come suddenly, usually without obvious trigger, 1 minute before it is fine, suddenly feel like they can not, mostly within 10 minutes to reach the peak of the attack, usually 30 minutes to natural relief, the patient is conscious during the attack, afterwards can recall the onset process. The physical symptoms include chest tightness, chest pain, shortness of breath, sweating, numbness of the limbs, etc. More prominent are palpitations, with heart rate up to 180 beats/min. A few patients may have abnormally high blood pressure (especially systolic blood pressure). In addition to inexplicable fear, typical symptoms include a sense of near death, a sense of loss of control, fear of going crazy, fear of jumping off a building, fear of cutting people with a knife, etc.; a feeling that objective things are not real, strange, like a veil; or a sense of self unreality. Patients often call the “120” emergency system, but physical examination is usually not abnormal except for tachycardia, and symptoms are often relieved when the doctor conducts an examination or even after seeing the medical personnel. During the interictal period, the patient often has a sense of unease and fear due to the fear of having another attack. Clinically, panic disorder is highly likely to be misdiagnosed as cardiovascular disease, such as angina pectoris and myocarditis. In fact, some patients have sudden onset of chest tightness, crushing pain in the precordial region, profuse sweating, pale face, weakness of limbs, headache, dizziness, blurred vision, sometimes a sense of near death, and extreme fear, with symptoms very similar to angina pectoris. During an attack, the ECG usually shows sinus tachycardia, and occasionally ST-segment depression or T-wave inversion, but the intervals are generally normal. Many patients who have undergone coronary angiography show no narrowing of the arteries, but after taking vasodilator drugs, they still have episodes of chest tightness and chest pain, extreme emotional stress, insomnia, and loss of appetite, and then they go to psychiatry or psychiatric departments. It is also important to note that many cardiovascular and respiratory diseases are often combined with panic disorder, and the prevalence of panic disorder in patients with chronic heart failure and hypertension is about 10% and 13%. Patients with paroxysmal supraventricular tachycardia, mitral valve prolapse, asthma, chronic obstructive pulmonary disease, and Meniere’s disease also often have a combination of panic disorder. Patients with panic disorder tend to be more sensitive, have more severe symptom complaints than objective signs, have difficulty tolerating pain, are especially fearful of disease and death, are very concerned about changes in symptoms and test results, and are often “startled” and always ask “what to do” repeatedly. “The doctor feels “very difficult”. Panic disorder often aggravates the primary disease, prolongs the course of the disease, and is detrimental to the patient’s recovery, so timely identification and management of panic disorder is also very necessary. Of course it is not true that all panic attacks mean that one has panic disorder. Somatic disorders such as hyperthyroidism, pheochromocytoma, and partial complex seizures in epilepsy can also present with typical panic attacks.