Question 1

My patient came to the ED with chest pain and palpitations - how do I tell if it's panic or a cardiac event?

Accepted Answer

67% of patients eventually diagnosed with paroxysmal SVT by electrophysiology met full panic disorder criteria, with a median diagnostic delay of 3.3 years. Women are twice as likely to have cardiac symptoms attributed to psychiatric causes. Standard 24-hour Holter monitors frequently miss sporadic arrhythmias — prolonged 14-to-30-day event monitors should be considered. The minimum medical workup for new-onset anxiety includes CBC, CMP, thyroid function, urinalysis, and drug screen before a primary psychiatric diagnosis is made.

Question 2

What percentage of ED chest pain visits are actually panic?

Accepted Answer

67% of patients eventually diagnosed with paroxysmal SVT by electrophysiology met full panic disorder criteria, with a median diagnostic delay of 3.3 years. Women are twice as likely to have cardiac symptoms attributed to psychiatric causes. Standard 24-hour Holter monitors frequently miss sporadic arrhythmias — prolonged 14-to-30-day event monitors should be considered. The minimum medical workup for new-onset anxiety includes CBC, CMP, thyroid function, urinalysis, and drug screen before a primary psychiatric diagnosis is made.

Question 3

What workup should I do before diagnosing panic in the emergency setting?

Accepted Answer

67% of patients eventually diagnosed with paroxysmal SVT by electrophysiology met full panic disorder criteria, with a median diagnostic delay of 3.3 years. Women are twice as likely to have cardiac symptoms attributed to psychiatric causes. Standard 24-hour Holter monitors frequently miss sporadic arrhythmias — prolonged 14-to-30-day event monitors should be considered. The minimum medical workup for new-onset anxiety includes CBC, CMP, thyroid function, urinalysis, and drug screen before a primary psychiatric diagnosis is made.

Question 4

Once cardiac causes are ruled out, how do I prevent the patient from returning to the ED for the same symptoms?

Accepted Answer

67% of patients eventually diagnosed with paroxysmal SVT by electrophysiology met full panic disorder criteria, with a median diagnostic delay of 3.3 years. Women are twice as likely to have cardiac symptoms attributed to psychiatric causes. Standard 24-hour Holter monitors frequently miss sporadic arrhythmias — prolonged 14-to-30-day event monitors should be considered. The minimum medical workup for new-onset anxiety includes CBC, CMP, thyroid function, urinalysis, and drug screen before a primary psychiatric diagnosis is made.

Question 5

Does repeated cardiac testing in reassurance-seeking panic patients cause harm?

Accepted Answer

67% of patients eventually diagnosed with paroxysmal SVT by electrophysiology met full panic disorder criteria, with a median diagnostic delay of 3.3 years. Women are twice as likely to have cardiac symptoms attributed to psychiatric causes. Standard 24-hour Holter monitors frequently miss sporadic arrhythmias — prolonged 14-to-30-day event monitors should be considered. The minimum medical workup for new-onset anxiety includes CBC, CMP, thyroid function, urinalysis, and drug screen before a primary psychiatric diagnosis is made.

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Panic vs. Cardiac Emergency: The ED Differential