A 30-year-old man was brought to the emergency room with complaints of chest pain with palpitations, sweating, and shallow breathing. ECG shows a sinus tachycardia with no remarkable findings. Upon further questioning, he reports that he has been having episodes of chest pain with palpitations and associated sweating every few days. On still further questioning, it is found out that he is stressed about work and fearful of losing his job. Lab evaluation shows normal troponin as well as normal TSH and vitamin B12. What is the most likely diagnosis:

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It is panic attack He is under fear of loosing job ie loss of confidence hence stress and anxiety induced panic situation

Thanx dr Narendra Kumar

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Panic attack Loss of job or tossing work place decrease blood pressure means heart rate means oxygeon and other minitrials reduces body energy anxiety and stress sadd further. Pl maintain age body structure ,body weight and family circumstances.

Thanks 👍

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Panic Attack Asthma..

Thanks doctor Govind pardhan

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4. Panic attack. Cardiac Neurosis following anxiety and fear of loosing the job. Clonazepam 0.5 mg dispersible tab. 1 tab once for 4 days.


Normal TSH rules out hyperthyroidism as diagnosis ECG showing sinus tachycardia with no remarkable finding along with normal troponin rules out myocardial infarction Stress related chest pain and palpitation confirms panic attack as diagnosis

The qizz lacks objective evidence in the form of any clinical findings. Entirely depends on patient's statements which leaves to guess work . All point out to panic attacks. But that should not put a lid on meticulous clinical examination . With clinical findings such quiz would be meaningful . Some emergencies like MI are associated with increased adrenergic drive which are no different from panic attacks. ECG takes time to record MI findings and repeat ECG is must not to miss MI . There is no double minds about the answer given which is expected by the quiz master.

Panic attack or Asthama can be the point to be focused since TSH levels are same so it can't be Hyperthyroidism Normal Troponins can be used to rule out MI Hypoglycemia has other features too such asShakiness, Anxiety,Sweating,Hunger, Pale skin.

My answer is absolutely , Panic Attack. And also anxiety, fears of the out side.

Thank you Sir@Gopal Yadav .

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Panic attack / Anxiety Rx Tab.Buspin 10mg BD Normal TSH , Troponin Rule out Hyperthyroidism, MI . Asthma Not associated with palpitations and sweating Hypoglycemia symptoms like Emotional change , rages , Unconsiousness with unresponsive , Cerebral edema , Seizure

Panic Attack / Anxiety Rx Tab Alprazolam 0.25mg 1 HS ,Tab Vitamin B Complex 1 OD for 10days , And Reassurance

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