It's a very difficult position for a patient. Every message you hear says to not doubt yourself when you're having chest pain. And the symptoms of a heart attack and panic attack can overlap quite closely. As someone whose original primary diagnosis was panic disorder, I've never been to an ER for chest pain, even though I've thought I should go at times. I've been talked out of it and waited to see an outpatient doctor.
For a person with panic disorder, if they come in with chest pain, and you have actually ruled out heart attack (done a very sensitive troponin test or whatever is done these days), and you've explained that the problem was a panic attack, I see it being unlikely for them to return, unless there was another problem like hypochondria or somatoform disorder.
My thought is that the best course of action is to provide good medical information as to the cause of the chest pain and rule out heart attack. You also have to remember that things besides panic disorder can trigger chest pain and then cause panic. For example, there can be soreness in the cartilage of the chest or acid reflux, etc. These pains can trigger anxiety, rather than anxiety triggering the pain. It's good to find an actual cause and explain how the anxiety reaction works--that the body may have a hypersensitivity to certain sensations.
But I think the chest pain issue is one that is simply difficult for both patients and doctors with all the messages you see that say in no uncertain terms to not doubt and it's better to be safe than sorry. I've struggled with this myself as I live with my parents and my father is from a Christian Science background and my mother is well . . . not the compassionate type. I actually had a time I had severe chest pain and was concerned it was dissection as I have a dilated aortic root, and my primary care doctor wanted me to go into the ER. My mom was home and wouldn't take me. I told her I was getting a cab. She called my father who was out of state on a business trip, and he called me crying asking me why I was tearing our family apart. I have may have anxiety, but they are nuts when it comes to health. My father practically has a nervous breakdown if I ask him to drive me to any non-scheduled medical appointment, such as Urgent Care. And my mother is just . . . non-involved.
Anyway, my original point was going to be that many ER visits are not what a patient's worst fear is. A case is either life threatening or it's not--and usually it's not. And given that chest pain is something that is supposed to be taken very seriously, I think the worst thing about unnecessary visits to the ER over a panic attack is probably the cost to a patient.
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How should panic attacks/disorder be treated in the ED?
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