Misdiagnosis of “panic disorder” as heart disease

       Recently, we met such a middle-aged male patient. One month ago, he suddenly felt his heartbeat accelerated, difficulty in breathing, chest tightness, profuse sweating, cold limbs, headache, dizziness, numbness of the limbs, and trembling all over his body. He had a feeling that he was going to die soon. The family immediately called “120” emergency. But when they arrived at the hospital, the above symptoms disappeared quickly. After examining the heart and other important organs, the patient was still uneasy and very afraid of heart problems. Later, he repeatedly went to the doctor, and had ECG, cardiac ultrasound, cardiac enzyme profile and other tests done many times, and the results were normal. He had been admitted to the emergency room three times in January, and the emergency physician suspected that he had a mental problem and recommended psychological counseling. He walked into the clinic with a helpless mind. After a detailed psychiatric examination, I found that the patient had a typical acute anxiety disorder – panic attack. A panic attack is also a psychological disorder in which the patient often feels a sudden and unexplained experience of panic, accompanied by a sense of near death, loss of control, and severe autonomic dysfunction symptoms. Patients feel as if death is imminent and run, scream, and call for help, with chest tightness, tachycardia, irregular heartbeat, dyspnea or hyperventilation, headache, dizziness, numbness and sensory abnormalities in the limbs, and autonomic symptoms such as sweating, facial flushing or pallor, tremor, gastrointestinal discomfort, and general weakness. Panic attacks usually have a rapid onset and termination. It rarely lasts more than an hour and resolves on its own. During the attack, the person is conscious and has post-attack palpitations and anticipatory anxiety for the next attack. The manifestations of panic attacks are more prominent in the somatic aspect, while the root cause is in the psychological aspect. There are many reasons for panic disorder, among which the main reasons are related to the patient’s personality, such as over-sensitivity and concern for their own body, strong “desire for life” and “terror of death”; “not afraid of one thing, but only afraid of one thing The patient’s personality is related to the patient’s over-sensitivity and concern about his own body, strong “desire for life” and “terror of death”, “not afraid of what if, but afraid of what if”, “the feeling of illness causes attention, attention to strengthen the feeling of illness”, and the lack and distortion of mental health knowledge. The main treatments for panic disorder include cognitive therapy, behavioral therapy, and other psychotherapeutic approaches. Panic disorder patients are often characterized by high expectations of life, excessive concern for themselves, poor understanding of the nature of the disease or half-understood, everything to the bad, always worried about the end of bad, long-term in a state of high alert, scare themselves, is bound to produce some distorted cognition. The seizure is accompanied by anxiety, causing muscle tension, autonomic dysfunction causing cardiovascular and digestive system symptoms. Therefore, cognitive therapy should be applied to change and correct the patient’s unreasonable and distorted cognition about the nature of the disease, so as to relieve himself of unnecessary tension and fear; behavioral therapy, such as relaxation training and systematic desensitization, should be applied to deal with the somatic symptoms caused by anxiety; Morita therapy should be applied to guide the patient to break the vicious circle of “the feeling of illness causes attention and attention strengthens the feeling of illness” and relax. Morita therapy is used to guide patients to break the vicious circle of “sickness causes attention and attention strengthens sickness”, to relax the body and mind, to return to nature, to follow nature, and often to receive twice the result with half the effort. Of course, drugs are also the main, commonly used, effective means of treating panic disorder, commonly used anti-anxiety drugs, antidepressants, etc., but it is best to use reasonably under the guidance of a specialist.