Question

In a patient with no significant previous history, no history of any drug intake, and a normal ECG, what is the likely cause of palpitations, sweating, and a feeling of impending doom, with each episode lasting about 10 minutes?

• A. Hysteria
• B. Panic attack
• C. Agoraphobia
• D. Generalised anxiety disorder

Hint:

A discrete, minutes-long episode of palpitations, sweating, and doom, with a normal heart workup, is the hallmark of a panic attack.

Answer 1

The Correct Option is B

Step 1: Understanding the Question:
A patient with no past illness, no drugs on board, and a normal ECG has short episodes, about 10 minutes each, of palpitations, sweating, and a feeling that something terrible is about to happen. We need the diagnosis that best explains discrete episodes like this.

Step 2: Key Concept:
A panic attack is a sudden burst of intense fear that peaks within minutes and comes with physical symptoms such as a racing heart, sweating, shortness of breath, chest discomfort, and a sense of impending doom or loss of control. It is discrete, meaning it has a clear start and end, unlike a constant background state.

Step 3: Detailed Explanation:
The normal ECG and the absence of drug intake rule out a cardiac arrhythmia or a stimulant-induced cause for the palpitations, which pushes the diagnosis toward a primary anxiety disorder.
The short, self-limited, episodic nature of the symptoms, about 10 minutes and then resolving, matches the defined course of a panic attack far better than a constant condition.
Hysteria, better called conversion disorder today, usually shows up as a loss of motor or sensory function, such as a limb that will not move or sudden blindness, not as episodes of palpitations and sweating, so it is a poor fit.
Agoraphobia is fear of situations where escape might be hard or help unavailable, such as crowds or open spaces; it is often a complication that develops after repeated panic attacks, not the direct cause of a single episode of palpitations and doom.
Generalised anxiety disorder is excess worry about everyday things spread across most days for six months or more, a steady low grade state, not a sharp 10 minute spike of fear and physical symptoms.

Step 4: Final Answer:
The sudden, short, intense episode of palpitations, sweating, and impending doom, with no cardiac or drug cause found, is a panic attack.