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Features

• Sudden attacks of fear or anxiety in situations of little danger
• Symptoms of the "flight or fight" response, complicated by hyperventilation and worsened by the fear of collapse or death
• Avoidance, for fear of panic, of situations from which escape is not possible or help is not available, typically public transport, travelling alone, crowded or lonely places

• Education about nature of disorder
• Hyperventilation control
• Graded exposure to feared situations
• Specialist referral to a cognitive behavioural program for non-responders

A 30-year-old woman asked her general practitioner to investigate her heart. She reported that several months ago, while attending a postnatal exercise class following the birth of her first child, she noticed a dramatic increase in her heart rate. She also noticed that her breathing became difficult, there was tingling in her fingers and around her mouth, her muscles became stiff, and she felt pains in her chest. Fearing she was having a heart attack, she fled the class and sought help at the local emergency department, where an ECG showed no abnormality. Since then, she had experienced similar symptoms on numerous occasions, always seeking medical advice for reassurance. She could travel alone, provided she carried her mobile phone in case she needed to call for emergency medical help. Even so, she avoided crowded banks, shopping centres, and movies in case medical help would not be able to help her in time should she experience another "heart attack".

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