Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

Anxiety Panic

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In one line

·A panic attack is a sudden wave of intense fear with a racing heart, trouble breathing, chest pain, and dizziness that peaks in minutes even when there is no real danger.

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Normal physiology

·Normally, your brain's amygdala (alarm center deep in the brain) detects threats and signals your body to prepare for danger—faster heart rate, quicker breathing, muscle tension. Your prefrontal cortex (thinking brain in the front of your skull) evaluates whether the threat is real and calms the alarm when it is not. This fear-then-calm cycle keeps you safe without constant panic.

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What goes wrong

·The amygdala fires an intense threat signal even when no danger exists, and the prefrontal cortex fails to shut down that alarm fast enough. Your body interprets normal sensations—like a skipped heartbeat or slight dizziness—as catastrophic danger, amplifying the alarm into a full panic attack.

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Hallmark signs

·Palpitations or pounding heart
·Sweating
·Trembling or shaking
·Shortness of breath or feeling smothered
·Chest pain or discomfort
·Nausea or stomach pain
·Dizziness, lightheadedness, or feeling faint
·Tingling or numbness in fingers, face, or around the mouth

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Red flags · escalate now

·Chest pain with abnormal ECG (heart tracing), high troponin (a blood test that shows heart muscle damage), or risk factors for a real heart attack (such as diabetes, high blood pressure, smoking, or family history)
·Sudden shortness of breath with low oxygen (hypoxia), unequal breath sounds on exam, or risk for a blood clot in the lung (pulmonary a traveling clot lodging in a vessel (embolism), especially after surgery, long flight, or leg swelling)
·First panic attack ever in someone over 45 with no history of anxiety—must first rule out heart disease, thyroid problems, or medication or drug causes
·Thoughts of suicide or a plan to hurt yourself, especially if panic disorder happens together with major depression or alcohol or drug use
·Cannot leave home, lost job, or life is severely limited by fear of having another attack (called agoraphobia)—needs urgent referral to a psychiatrist or therapist

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Workup

·Electrocardiogram (ECG)
·Cardiac troponin I or T
·Thyroid-stimulating hormone (TSH)
·Basic metabolic panel (sodium, potassium, glucose, creatinine)
·Urine drug screen
·D-dimer (if chest pain, shortness of breath, and risk factors for clot present)
·Chest radiograph (X-ray)
·Oxygen saturation by pulse oximetry

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Treatment

·Controlled breathing technique: slow to 6 breaths per minute (inhale through nose for 4 seconds, exhale through mouth for 6 seconds) during acute attack
·Selective serotonin reuptake inhibitor (SSRI) such as sertraline 25 to 50 mg daily, paroxetine 10 to 20 mg daily, or escitalopram 5 to 10 mg daily, started low and increased gradually over 2 to 4 weeks
·Cognitive-behavioral therapy (CBT) with interoceptive exposure: patient deliberately triggers panic sensations (rapid breathing, spinning to create dizziness) in a safe setting, then practices staying calm and reinterpreting the sensations as harmless
·Benzodiazepine such as lorazepam 0.5 to 1 mg or alprazolam 0.25 to 0.5 mg as needed for severe attacks, or short-term bridge (1 to 4 weeks) while waiting for SSRI to start working
·Psychoeducation: explain to patient that panic attacks are not dangerous, cannot cause heart attack or death, and will always pass within 20 to 30 minutes
·Prevention of avoidance and agoraphobia: encourage continued engagement in daily activities, use of public spaces, and travel even when anxious

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NCLEX trap

·Beta-blockers slow a fast heart (over 100 beats per minute) during a panic attack, but they do NOT fix the broken alarm system in the brain's fear center (the amygdala). An SSRI like sertraline fixes the deeper problem—it boosts serotonin in the brain circuits that control fear, so false alarms stop firing. Think of it like this: a beta-blocker turns down the fire alarm's volume, but an SSRI fixes the faulty wiring so the alarm stops going off for no reason. Beta-blockers give quick relief; SSRIs are the real fix. Per APA guidelines, SSRIs or SNRIs plus cognitive-behavioral therapy (CBT) are first-line treatment for panic disorder.
·ALWAYS rule out the killers first: heart attack (check troponin and EKG), blood clot in the lung (pulmonary a traveling clot lodging in a vessel (embolism)—check D-dimer if clinical suspicion is present), dangerous heart rhythms (arrhythmia), overactive thyroid (hyperthyroidism—check TSH), and stroke. A normal EKG, negative troponin, and clear chest X-ray mean the heart and lungs are safe—but that does NOT prove panic disorder. Panic disorder is diagnosed AFTER you rule out the dangerous causes AND the patient has recurrent unexpected attacks plus at least one month of ongoing fear of the next attack or starts avoiding places (like refusing to drive or go to crowded stores), per DSM-5-TR criteria.
·Panic disorder means the person has sudden terror attacks (heart racing, can't breathe, feeling like they're dying) that peak in minutes, PLUS at least one month of constant worry about the next attack or avoiding places where escape feels hard (like elevators, highways, or crowds). Between attacks, the patient often feels and looks totally fine. The giveaway is the avoidance pattern—refusing to drive, take the bus, or go into stores. If you see that, panic disorder is likely, even if they seem calm right now. This is how the brain's false alarm works: it fires suddenly, then shuts off, leaving the person exhausted and terrified of the next surprise attack.
·Benzodiazepines (like lorazepam or alprazolam) work fast—they calm the brain in 30 to 60 minutes by boosting GABA (the brain's main calming chemical that slows activity). But they do NOT fix the root cause. Long-term use causes three big problems: (1) your body gets hooked (physical dependence), (2) you need higher doses over time (tolerance), and (3) thinking gets foggy (cognitive impairment). Per APA guidelines, SSRIs or SNRIs PLUS cognitive-behavioral therapy (CBT) are first-line treatment. Save benzodiazepines for short-term use only—like covering the first two to four weeks while the SSRI starts working, or for rare situational panic (like a flight if someone fears flying).
·Slow belly breathing (using the diaphragm, the big dome-shaped muscle under your lungs) helps in two ways: it stops you from breathing too fast (hyperventilation), which causes tingling and dizziness because your blood carbon dioxide drops (hypocapnia), and it turns on the calm branch of your nervous system (the parasympathetic system, which slows the heart and relaxes muscles). But here's the key: panic attacks ALWAYS peak at 10 minutes and fade by 20 to 30 minutes no matter what you do, because your body can't keep pumping out maximum adrenaline (epinephrine) that long—the supply runs low. Breathing exercises make the patient feel less out of control and prevent symptoms from getting worse, but they don't shut the attack off like a switch. Teach this: the attack WILL pass on its own, and it's not dangerous.
·Panic disorder is a brain wiring problem. The fear center (amygdala), memory center (hippocampus), and thinking center (prefrontal cortex—the front part of the brain that applies the brakes to big feelings) are not communicating right, and chemicals like serotonin (a brain messenger that steadies mood and fear responses), norepinephrine (a stress chemical), and GABA (the brain's main calming signal) are out of balance. The symptoms are real and measurable: fast heart (tachycardia), trouble breathing (dyspnea), sweating (diaphoresis), shaking (tremor). Panic disorder wrecks daily life—people lose jobs, stop seeing friends, and can't leave home. It's a medical diagnosis that needs medication (SSRI or SNRI) and therapy (CBT), not just 'calm down' advice. Dismissing it is wrong and harmful.

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