Panic Attacks and Anxiety: What Is Happening, What Helps, and When Chest Pain Needs a Hospital

It often starts out of nowhere. You are sitting in a meeting, driving home on the Outer Ring Road, or lying in bed, and your heart suddenly pounds. Your chest tightens, your hands tingle, you cannot get a full breath, and a thought arrives with complete certainty: something is badly wrong. Many people who have their first panic attack are sure it is a heart attack, and some go straight to a hospital.

Others never have a dramatic attack. They simply worry, most days, about most things, and cannot switch it off.

Both are common, both are treatable, and neither is a weakness of character. This page explains what is going on, what helps, and the signs that mean you should go to a hospital first.

What anxiety and panic actually are

Anxiety is the body's alarm system. Adrenaline speeds the heart, quickens breathing and tenses the muscles. That is useful when a car swerves towards you. It becomes a problem when the alarm goes off too often, or with no danger at all.

Doctors usually describe a few patterns:

- A panic attack is a sudden surge of intense fear with strong physical symptoms. Most panic attacks last between 5 and 20 minutes. They feel dangerous, but a panic attack on its own does not damage the heart.

- Panic disorder is when panic attacks keep coming back unexpectedly, and the fear of the next one starts to change how you live: avoiding the metro, crowded markets, driving, or being alone.

- Generalised anxiety is worry that is hard to control, about many different things, on most days, for months. It tends to come with tiredness, poor sleep, irritability and difficulty concentrating.

There is rarely a single cause. A stressful period, a bereavement, a family history of anxiety, a long-term illness and heavy drinking all raise the chances. Some physical conditions produce the same symptoms, which is why a doctor should examine you rather than assume it is "just stress".

Symptoms, in the words people actually use

- "My heart suddenly starts racing for no reason"

- "I feel like I can't breathe, or can't get a full breath in"

- "My chest goes tight"

- "My hands and lips tingle, and I go shaky"

- "I feel dizzy, like I might faint"

- "I get a wave of fear that I'm about to die or lose control"

- "I've stopped taking the metro in case it happens again"

- "I can't stop worrying, even about small things"

- "I wake at 3 am and my mind starts running"

If these are affecting your work, sleep or family life, it is worth seeing a doctor. You do not have to wait until it is unbearable.

🔴 When to go to a hospital, not a clinic

Chest pain should never be assumed to be anxiety until a heart problem has been considered. Go to a hospital emergency department, or call 112, if:

- You have chest pain that feels crushing, squeezing or tight, or that spreads to your arm, neck, jaw or back

- This is the first time it has happened and you are over 40, have diabetes, high blood pressure or high cholesterol, smoke, or have a family history of heart disease

- You are very breathless, gasping, or cannot speak in full sentences

- Your lips or skin look pale, blue or grey, or you are sweating heavily and feel sick

- You faint, or someone near you collapses and does not respond normally

- The symptoms began after taking a medicine, a drug or a large amount of alcohol, or after stopping one suddenly

- The episode is different from your usual attacks, lasts much longer, or does not settle

Do not drive yourself. Bring any medicines you take, or their strips.

If you are having thoughts of ending your life or harming yourself, call 112 or go to the nearest hospital emergency department now. You can also call Tele MANAS on 14416, the Government of India's free mental health helpline, which is available 24 hours a day in 20 Indian languages. Please do not wait for a clinic appointment.

Once a hospital has ruled out a heart problem, the follow-up for panic belongs with a doctor who can treat the anxiety, not in repeated emergency visits.

## During a panic attack: what to do

These steps do not stop every attack, but they stop it from feeding on itself:

- Stay where you are if it is safe. Sit down if you can. Running from the place tends to teach the brain that the place was dangerous.

- Slow your breathing down. Breathe in slowly and gently through your nose, and out through your mouth, counting steadily to five on each breath.

- Name it. Tell yourself: "This is a panic attack. It is uncomfortable, and it will pass." If you have had your heart checked and been told this is panic, remind yourself of that.

- Let the feelings rise and fall rather than fighting them.

Do not breathe into a paper bag. It is old advice, it can lower your oxygen level, and it is no longer recommended.

What actually helps

Anxiety and panic respond well to treatment, though it takes weeks rather than days.

- Talking therapy, especially cognitive behavioural therapy (CBT). CBT teaches you to recognise the thoughts that turn a racing heart into a sense of danger, and to face what you have started avoiding, step by step. International guidance from the UK's National Institute for Health and Care Excellence (NICE) recommends it as a main treatment for panic disorder, typically around 7 to 14 hours in total. A Cochrane review of psychological therapies for panic disorder found CBT among the most consistently effective, though it noted that much of the research is of limited quality.

- Guided self-help. For milder anxiety, a structured self-help programme, with a doctor checking progress, helps many people.

- Regular physical activity. A large review of the research, published in the British Journal of Sports Medicine in 2023, found that physical activity improves symptoms of anxiety as well as depression. Brisk walking, cycling, yoga or swimming all count. On Delhi's worst air days, do it indoors.

- Cut down on caffeine. Strong tea, coffee, cola and energy drinks can trigger palpitations and make anxiety harder to control.

- Be honest about alcohol. It calms anxiety for an evening and makes it worse the next day. Many people find their attacks come on the morning after drinking.

- Medicine, when it is needed. For moderate or long-lasting anxiety, a doctor may suggest a daily medicine from the antidepressant family. These are not habit-forming, they take a few weeks to start working, and they are usually continued for several months once they help. The doctor will explain the side effects and how to stop safely, and you decide together.

What we will not do

- We will not tell you it is "all in your head" before anyone has examined you. A racing heart, chest tightness and breathlessness can have physical causes, including thyroid problems and heart rhythm problems, and those are considered first.

- We will not use fast-acting calming tablets of the habit-forming kind as the long-term answer. NICE advises against them for panic disorder, because they are linked to a worse outcome in the long run. If one is ever used, it is for a short, defined period, and the doctor will tell you why.

- We will not send you for every test available. If your examination and history point clearly to anxiety, we will say so, and explain which tests are worth doing and which are not.

- We are not an emergency or crisis service. Our psychiatrist sees patients by appointment in the evening, and the clinic is closed on Sunday. If you are in crisis, use the hospital and helpline details above.

- We will not sell you a package of sessions, tests or supplements paid for in advance. Each step is decided at the visit and priced before it is done.

Under the Mental Healthcare Act 2017, you have a right to confidentiality about your mental health care. You are welcome to come alone, or to bring someone with you if that helps.

What it costs

| | Fee |

|---|---|

| General physician consultation | from ₹800 |

| Psychiatry consultation | ₹1,200 |

| Blood count (CBC), if the doctor suggests it | ₹319 |

| Thyroid test or other tests the doctor suggests | quoted before it is booked |

Fees are for booking directly with us. Fees for appointments booked through third-party platforms are set on those platforms and may differ. Blood samples can be collected at home free of charge, with no minimum order. For any test the doctor suggests, we tell you the price before anything is booked.

Who you will see

If anxiety or panic is affecting your daily life, see a psychiatrist. A psychiatrist is a medical doctor who has specialised in mental health, so they can assess both the physical and the psychological side and prescribe medicine if it is needed. Dr. Abhishek Kalra (MBBS, MD (Psychiatry)), psychiatrist with more than 10 years' experience, consults Monday to Saturday, 5:00 to 7:00 PM. He will explain what is going on and agree a plan with you: therapy, medicine, both, or neither.

If you would like your body checked first, or cannot come in the evening, start with a general physician. Dr. Waquar Yunus (MBBS), our general physician, is in the clinic for the full clinic day, Monday to Saturday, 8:00 AM to 9:00 PM. He can examine you, check your pulse and blood pressure, arrange blood tests, and refer you to Dr. Kalra if that is the right next step.

Before your visit, note when the attacks happen, how long they last, and how much tea, coffee and alcohol you have each day. Bring the strips of any medicines you take, and any hospital reports.

Frequently asked questions

Can a panic attack cause a heart attack?

A panic attack on its own does not damage a healthy heart, although it can feel exactly like one. The difficulty is telling them apart in the moment. If the chest pain is new, crushing or spreading, or you have heart risk factors, treat it as a possible heart attack and go to a hospital.

How do I know whether it is anxiety or something physical?

You often cannot tell on your own, which is why the first step is an examination. A doctor will check your pulse, blood pressure and heart, and may suggest a blood test, including a thyroid test, before concluding it is anxiety.

Will I have to take medicine for life?

No. Many people improve with talking therapy and lifestyle changes alone. When medicine is used, it is usually taken for some months after you feel better and then reduced gradually with the doctor's guidance.

Are anxiety medicines addictive?

The medicines most often used long term, from the antidepressant family, are not habit-forming, though they should not be stopped suddenly. Fast-acting calming tablets can cause dependence, which is why they are kept for short periods only.

Is it safe to exercise if I get palpitations?

For most people, yes. If the palpitations come with chest pain or fainting, see a doctor before starting anything strenuous.

Can I come without an appointment?

Please call first and we will give you a time. Dr. Kalra consults in the evening, so booking ahead saves a wasted trip. If you have chest pain or are thinking of harming yourself, go to a hospital emergency department instead.

All Is Well Medical Centre

Shop no. 1, Central Market, Sector B Rd, opposite Vasant Square Mall, Masoodpur, Sector B, Vasant Kunj, New Delhi, Delhi 110070

Clinic hours: Monday to Saturday, 8:00 AM – 9:00 PM. Closed Sunday.

Phone: 8800844793 · WhatsApp: https://wa.me/918800844793 · Book an appointment: https://alliswellmedicalcentre.com/doctors-appointments

Rated 4.9★ by patients on Google.

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Medically reviewed by Dr. Abhishek Kalra, MBBS, MD (Psychiatry) — psychiatrist, All Is Well Medical Centre.

This article is general information and is not a substitute for a consultation with a doctor. If you are worried about your symptoms, please see a doctor. In an emergency, call 112 or go to the nearest hospital.

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Shop no. 1, Central Market, Sector B Rd, opposite Vasant Square Mall, Masoodpur, Sector B, Vasant Kunj, New Delhi, Delhi 110070

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