Shortness of Breath: Anxiety or Coronavirus?

You wake up at 2:00 in the morning. You can't take a deep breath, and your chest hurts, and your heart is pounding. Is this coronavirus, or is it a panic attack?

These are anxious times. Economic insecurity, worries about friends, and the 24-hour news cycle of death and disaster elevate everybody's stress hormones. Increased anxiety sets off the alarms of your sympathetic nervous system, your fight-or-flight system. Your heart rate increases. Your muscles tighten. You start to breathe faster. These can be symptoms that anxiety can cause all day long or just for a short period of time, and this is anxiety or a state of anxiety. These can be symptoms that anxiety can cause all day long.

However, sometimes for no good reason, the body is suddenly flooded with the stress hormone called norepinephrine, and these symptoms are amplified. This is called a panic attack. You can't catch your breath. You can't seem to take a deep breath. Your heart is pounding out of your chest, and you may have chest pain or feel that there's a heavy weight on your chest. You're pretty sure you're going to die.

These symptoms were often confused with the symptoms of a heart attack. Panic attacks come on suddenly, and heart attacks come on suddenly, so it's not uncommon for emergency rooms to see younger people who come in with symptoms of a heart attack who leave with the diagnosis of a panic attack. Of course, the long-term consequences of a panic attack are different than a heart attack, and the management is different.

Now, however, in the days of the COVID-19 epidemic, we're hearing the symptoms of infection that include rapid breathing, feeling that you can't take a deep breath, heart pounding, and pain or pressure in your chest. So how can you tell the difference? Of course, if you're in the emergency room, we have the tests and equipment that can help us to quickly sort this out.

The first is to take a history. Have you had a fever? A fever is common with COVID-19 and rarely seen with panic attacks. People with panic attacks can get sweaty, as can people with fever when it breaks, but the body temperature doesn't usually spike with a panic attack.

Have you had a cough? A cough is common for COVID-19 but not in panic attacks. Have you had muscle aches and pains over the past several days? That's common for COVID-19 and not so much for panic attacks. Did all this come on all of a sudden? Which is rare for COVID-19 that usually builds up over a day or so. Panic attacks come on all of a sudden and usually only last less than 30 minutes at their worst.

Then in the ER, we have this little amazing device that we can put on your finger to measure your oxygenation. If that's normal, then your difficulty breathing isn't likely to be COVID-19. We can also get a chest X-ray, which would be normal in a panic attack, but not in the case of severe shortness of breath from COVID-19. Of course, we can get a cardiogram to help rule out a heart attack, and we can take your temperature. Actually, that was done in triage before you even got into the emergency room, as was the pulse ox, that cute little thing on your finger.

But you aren't in the ER. You're at home in bed in the dark thinking you're going to die, or maybe it's in the middle of the day or maybe you're driving. If you're driving, pull over immediately. If you're in bed, get up and sit upright in a comfortable chair. If you're not alone, get someone to help and be with you, and tell them how you're feeling. Take some slow, deep breaths all the way in for a count of four, hold for four, all the way out for a count of four, hold for four. If you can't do it for the four count, do it for three or speed up to four. Do that 10 times and count them.

Then ask yourself the questions: Do you have a fever? Have you had a fever? You can take your temperature if you have a thermometer at home, and it really helps to have a thermometer at home. If you're too stressed to find the thermometer, maybe someone could help you. No fever? This is good; 10 more breaths. Do you have a cough? Have you had a cough in the last couple of days? If not, that's a good sign, 10 more breaths. Did this come on all of a sudden, or have you had weakness, muscle fatigue, and fatigue for several days? No? That's a good sign, 10 more breaths.

How are you doing? Check in with yourself from toes up. How are the bottom of your feet on the floor feeling? How are your toes feeling? How are your knees feeling? How's your butt feeling in that chair? Take time to check out each part of your body. It will give your anxious brain some work to do. Mostly okay? That's good.

So if you're feeling better and you've answered to yourself no to all these questions, you're probably having a panic attack. If you answered yes to fever and cough and the symptoms are getting worse over the past couple of days, call your clinician or the ER, and they can send you where you should be seen. If there's any other way, please do not drive yourself. If you can't get someone to drive you and you cannot breathe slowly and you're still have pain or pressure in your chest, call 911 and the EMTs will come to help.

These are difficult times. Gloom and doom are part of everyday news cycle. Please, turn off the news for a while every day. Get out and walk about in a physically distanced way. The phrase "socially distance" isn't the right one. Physically distance is the right thing. Exercise is one of the best things for long-term therapy for anxiety. Reach out to friends on the phone. Stay connected. Call us if you need us, and thanks for joining us on The Scope.