Patients with panic attacks are often afraid that they will die suddenly from myocardial infarction or asphyxia, and this fear aggravates the anxiety and makes the symptoms more frequent. Palpitations and rapid heartbeat occur during physical activity and are considered normal by everyone, but if they occur at rest, they are a cause for concern and fear. Because it seems unexplainable, however, psychological factors alone (anxiety, chagrin, anger) may cause severe palpitations. However alarming such palpitations and heartbeats may feel, they do not cause myocardial infarction as a result. The most significant symptom in a patient with a myocardial infarction is severe precordial pain, not a change in heart rate. A panic attack with chest tightness and a feeling of throat obstruction is caused by excessive tension in the chest muscles and spasm of the laryngeal muscles. Fear causes shortness of breath, resulting in hyperventilation, which decreases the carbon dioxide level in the body and causes a temporary lack of calcium in the blood, causing muscle spasms. The tight muscles compress the blood vessels, causing tingling and numbness in the limbs, spasmodic sensations in the lips, palms, and feet, as well as compression and tightening sensations in the chest and neck. In addition, some symptoms of nausea, abdominal discomfort, and visual disturbances may occur. Hyperventilation can also cause vasoconstriction in the brain and compromise the supply of oxygen, causing dizziness, a sense of unreality, inability to concentrate, interruption of thinking, and yes, more intense anxiety. All symptoms of hyperventilation will disappear if you take normal or slow breaths and combine them with physical activity. There is no need for tranquilizers or paper bag breathing, all that is needed is to take deep breaths. Many people with panic disorder fear they will go crazy and act out of control. In fact, patients often confuse high levels of nervousness with confused thinking and fear that they will snap. Patients often experience a strange sense of detachment from their surroundings (a sense of loss of self, of unreality). This experience occurs not only during panic attacks, but also in situations of shock or fatigue (e.g., an accident or learning of the death of a loved one) and is not a split personality. Patients with panic disorder are “emotionally disordered”, while reason and control of reality remain normal. So far, no one has ever had a panic disorder that led to schizophrenia. The physician needs to help the patient identify all of the catastrophic thoughts, imagery, and internal dialogue that occurred during the panic, comment on the catastrophic thoughts in written assignments, question them, and gradually guide the patient to create positive and assertive experiences and statements, revisit these positive statements repeatedly, and self-direct. Panicked patients over-evaluate “danger” because their cognitive structures or schemas predispose them to catastrophic interpretations of common situations. The problem is only truly resolved when the underlying dysfunctional assumptions are repeatedly reviewed and the patient is able to welcome and accept new ideas and information and transform his or her beliefs and attitudes.