An insurance agent who is sitting in his office after returning from a cardiovascular examination in which he was pronounced "in good health" suddenly experiences a feeling of terror

Question

His heart pounds, he feels as though he cannot breathe, and he cannot focus on what is being said to him. Several earlier episodes (for which he was seen in the emergency room, without any findings of cardiovascular disease) and the fear of their repetition had prompted the visit to the doctor for a more thorough evaluation. This experience should be assessed as a possible: a. panic attack.
b. myocardial infarction.
c. dissociative reaction.
d. acute stress disorder.

Answer 1

A
According to the DSM-IV-TR, panic attacks cause symptoms of sympathetic nervous system arousal and occur without warning, as described in the scenario. Although panic attacks can mimic cardiovascular events such as myocardial infarctions, in this case the patient has had multiple medical evaluations for the same presentation and cardiovascular disease has been ruled out, making panic attacks the more likely explanation. A dissociative reaction involves separation of an event from conscious awareness. Acute stress disorder is more akin to posttraumatic stress disorder, and most of its symptoms are not evident here (e.g., acute stress disorder follows a traumatic event, which is not the case here).