Chest pain: Panic attack or heart attack?

Chest pain is a common presentation to both primary and secondary care phys icians but is often non-cardiac in origin. Patients presenting with chest: pain may be experiencing a panic attack. Panic disorder is a disabling psyc hiatric condition with serious consequences, such as impaired social functi oning and increased risk of suicide. Comorbidity of panic disorder with oth er psychiatric conditions is common and often leads to increased severity o f anxiety symptoms and a poorer prognosis. The cost of misdiagnosing non-ca rdiac chest pain is high. it is important for physicians to be able to reco gnise panic attacks and to distinguish them from cardiac disease, thus avoi ding unnecessary use of healthcare resources. This review discusses the pre valence and diagnosis of panic attack and panic disorder in patients presen ting with chest pain to primary care physicians and cardiologists. Treatmen t options for panic disorder are considered, particularly the selective ser otonin reuptake inhibitors, which are emerging as the first-line choice for the treatment of panic disorder.