ABSTRACT
This chapter presents a case of a 36-year-old schoolteacher who is brought in by the paramedics to the emergency department. This is her fifth presentation in 4 weeks. She woke up from her sleep last week drenched in sweat and experiencing an intense constricting chest pain. She appears calmer but shaken. She is drenched in sweat and still tremulous. She has tachycardia and tachypnoea, but blood pressure is normal. There is no other significant abnormality. Her electrocardiogram is normal. Random blood sugar, thyroid profile, serum calcium and urine drug screen are also normal. Short-acting benzodiazepines such as alprazolam and lorazepam reduce the frequency and intensity of panic attacks but carry a high risk of dependence and are therefore not recommended. Tricyclic antidepressants such as imipramine and selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine are effective though SSRIs may induce anxiety and agitation in the short term.
