Dear Reader,
I have attended so many patients suffering panic attacks this summer that I thought it would be interesting for you to know more about them. In medicine, it is particularly true that the best teacher is the patient. The person that taught me about panic attacks was my girlfriend in medical school. She was a highly-strung, very intelligent (and, of course, very pretty) psychology student who read too many scientific books. One night she had a classic panic attack, only the two of us did not recognise it as such. It started with her having pins and needles in her hands and feet and the feeling of a lump in her throat. As I said, she read too much and, from the initial symptoms, she diagnosed herself as suffering from tetanus.
We disregarded the diagnosis after reading more about it, but then she woke up in the middle of the night, shaking, with cramps in both arms. She also felt short of breath and these symptoms were, of course, causing a panic attack – in me too! I went next door to our neighbour, who was a physician. He had been fast asleep but it took him only a few seconds to recognise that my girlfriend did not have tetanus and was not suffering from a heart attack, but was experiencing a panic reaction or hyperventilation syndrome. He did not even need a Valium injection to heal her, reassuring words from an experienced doctor did the trick. Despite that, the patient had several episodes of the same symptoms over the next few days.
Panic attacks (hyperventilation spasm is probably the same phenomenon) come in many variations and there is no specific test you can do to ascertain the diagnosis. They are a fascinating illustration of how our body and mind are inter-linked and how powerful the influence of the mind can be on the body. The symptoms are shortness of breath, a tight feeling on the chest, the sensation of a ball in the throat (globus syndrome), pins and needles, cramps and shaking of the extremities, sweating, and the sensation of anxiety and panic. In the worst case scenario, panic attacks can even present like epileptic fits.
Patients do not imagine these symptoms – they have a real physical reason. When one experiences a worrying body sensation, one focuses more on it. Humans react to these circumstances by breathing deeper and faster. But breathing deeper and faster over a long period is like hyperventilating. When we hyperventilate, we create a metabolic reaction of alkalosis (an abnormal increase in alkalinity) in the blood. When there is alkalosis in our blood it means that more calcium is being bound onto proteins, leading to a lack of free and acting calcium in all systems. Calcium is an essential mineral for many tissues. A lack of it leads to cramps, hyper-excitability and faulty transmission of nerve impulses. This relative and temporary lack of calcium is responsible for the symptoms that can look so dramatic.
The treatment is reassurance, sedating medication and, occasionally, it is necessary to give calcium. It is very important to explain the mechanism of the panic reaction to the patient so that he or she can understand how to tackle them in the future. I am convinced that bystanders and traditional methods of dealing with threatening situations are among the reasons why hyperventilation syndromes occur in the first place. Haven’t we all been taught to breathe deeply when things are hurting or when we are anxious about something?
In the case of the last patient with a panic attack I attended this week, a first-aider was about to really get the patient in a state of deep hyperventilation by doing deep breathing exercises. He assumed that the patient was having a heart attack. I felt like my neighbour of 20 years ago – I immediately saw what was going on and sure enough the patient was soon better. No medication needed.
So here is my advice to you should you encounter this emergency:
• Use common sense. Young ladies under 45 are very unlikely to have heart attacks; they are more commonly affected by hyperventilation.
• Panicking patients are restless, shaking, anxious and often feel short of breath. The best action is to reassure them (that helps in any case).
• If you think the patient may be having a panic attack, sit quietly with him or her and practice calming and controlled breathing with them.
• Breathe together with the patient – no more than 18 times per minute and in a normal, even a bit superficial, fashion – no deep breathing!
Next month I will write about the interesting problem of sleep apnoea (a temporary inability to breathe). Until then, dear reader, please make the most of the beautiful September in the Algarve. Yours Dr Thomas Kaiser
Dr. Kaiser can be contacted at the Vale do Lobo Family Medical Centre on 289 398 411.
