Clinical cases
Severe anxiety and panic: a case-based approach
This is an illustrative educational case — not a real patient. Panic attacks can feel physically terrifying: a racing heart, chest tightness, breathlessness and a sense of impending doom that people often fear is a heart attack. This case shows how a clinician reasons through a first severe panic attack — taking the physical symptoms seriously while recognising the pattern.
Education and reference only. This article explains how treatments work in plain language — it contains no doses and is not a substitute for advice from your doctor or pharmacist. Always discuss your own treatment with a qualified clinician.
The presentation
A 28-year-old comes to an urgent care centre with a 20-minute episode of a pounding heart, chest tightness, tingling hands, dizziness and a feeling that something terrible is about to happen. It started suddenly while sitting quietly and is already easing. They have had two similar episodes recently and are now frightened of them happening again. The symptoms are real and distressing, and the first job is to make sure nothing physical is being missed before reaching a diagnosis of panic.
Taking the physical symptoms seriously
Panic and serious physical illness can share symptoms, so a first severe episode is assessed properly rather than dismissed. Chest pain, palpitations and breathlessness prompt a focused check — an ECG, observations, and consideration of causes such as heart rhythm problems, an overactive thyroid, low blood sugar or the effects of caffeine, stimulants or certain medicines. Reassuringly normal findings, together with the classic pattern of sudden onset, rapid peak and gradual settling, support panic — but the assessment is what makes that reassurance safe.
Recognising the panic pattern
A panic attack is a sudden surge of intense fear that peaks within minutes, with physical symptoms like a racing heart, sweating, trembling, shortness of breath and tingling, often with a fear of losing control or dying. Panic disorder is diagnosed when attacks recur and the person develops persistent worry about further attacks or changes their behaviour to avoid them. Over-breathing (hyperventilation) drives many of the physical symptoms, which is why they are frightening but not dangerous.
What helps in the moment and longer term
In the moment, slow breathing and grounding techniques help settle the surge. Longer term, the most effective treatment for panic disorder is a talking therapy — cognitive behavioural therapy (CBT) — which helps people understand the cycle and break it; in the UK this is available through NHS Talking Therapies, which people can often self-refer to. Some people benefit from medication, decided with a clinician. Reducing caffeine, alcohol and stimulants, and treating any underlying depression, also helps.
What the case teaches
The lesson is to hold two things at once: take the physical symptoms seriously enough to exclude the dangerous causes, and recognise the panic pattern so the person gets the right help rather than repeated investigations. Clear explanation — that the symptoms are a false alarm from the body's stress response, not a sign of physical harm — is itself part of the treatment, alongside therapy and support.
In short
Key takeaways
- Panic attacks cause frightening physical symptoms (racing heart, chest tightness, breathlessness) that peak within minutes.
- A first severe episode is properly assessed to exclude physical causes such as heart rhythm problems or thyroid overactivity.
- Panic disorder is recurrent attacks plus persistent worry about further attacks or avoidance behaviour.
- CBT (via NHS Talking Therapies, often self-referral) is the most effective treatment; some benefit from medication.
- Educational illustration only — sudden chest pain or breathlessness should be assessed; call 999 if severe or you are unsure.
Answers
Frequently asked questions
Is this a real patient?
No — it is a fictional teaching case for education and is not advice for any individual.
How do I know if it is a panic attack or a heart problem?
The two can feel similar, so a first severe episode of chest pain or palpitations should be checked by a clinician. If chest pain is severe, persistent, or comes with collapse or breathlessness, treat it as an emergency and call 999.
Can panic disorder be treated?
Yes. Cognitive behavioural therapy is very effective, and in the UK you can often self-refer to NHS Talking Therapies. Some people also benefit from medication, and reducing caffeine and alcohol helps.
Go deeper
Related guides
Sources
Where this is drawn from
- NICE CG113 — Generalised anxiety disorder and panic disorder in adults
- NHS — Panic disorder; NHS Talking Therapies
- Royal College of Psychiatrists — Anxiety, panic and phobias
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