The release of catecholamines during a panic

The release of catecholamines during a panic attack or significant stress can trigger an arrhythmia. Asking a single question, “Have you experienced brief periods, for seconds or minutes, of an overwhelming panic or terror that was accompanied by racing heartbeats, shortness of breath, or dizziness?” can help identify patients with panic disorder.
^ Treatment
After ambulatory monitoring, most patients with palpitations are found to have benign atrial or ventricular ectopy and nonsustained ventricular tachycardia. In patients with structurally normal hearts, these arrhythmias are not associated with adverse outcomes. Abstention from caffeine and tobacco may help. Often, reassurance suffices. If not, or in very symptomatic patients, a trial of a P-blocker may be prescribed. For treatment of specific atrial or ventricular arrhythmias, see Chapter 10.
^ When to Refer
• For electrophysiologic studies.
• For advice regarding treatment of atrial or ventricular arrhythmias.
^ When to Admit
• Palpitations associated with syncope or near-syncope, particularly when the patient is aged 75 years or older and has an abnormal ECG, hematocrit 24/minute, or a reputation of CHF.
• Clients alongside chances factors with a acute arrhythmia.
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