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Almost every week, someone sits down in my consulting room and says the same sentence: "Doctor, I think I had a heart attack, but the ECG was normal." Nine times out of ten, what they had was a panic attack — and the relief on their face when the difference is explained is often the first step in getting better.
Anxiety builds. Panic arrives.
Anxiety is a slow tide. It builds over hours or days, it attaches itself to something specific — an exam, a diagnosis, a conversation you are dreading — and it can sit in the background at a low hum for weeks. A panic attack is different in shape entirely. It peaks within about ten minutes, it is overwhelming, and very often there is no trigger you can point to at all.
What a panic attack actually feels like
- A pounding or racing heart, often with chest tightness
- Shortness of breath, or the feeling of being unable to fill your lungs
- Tingling in the hands or around the mouth
- A powerful sense that something catastrophic is about to happen
The physical symptoms are real — this is not "in your head" in the dismissive sense. Your body has fired a genuine alarm response. The problem is that it fired without a fire.
What helps in the moment
Slow your out-breath. Not deep breathing — slow breathing, with the exhale longer than the inhale. Four counts in, six counts out. This is not a folk remedy; lengthening the exhale directly engages the part of your nervous system that switches the alarm off.
When to come in
If panic attacks are recurring, or you have started avoiding places because you are afraid of having one there, that is the point at which treatment makes a real difference. Panic disorder responds very well to therapy, and often does not need medication at all.
