What are the symptoms of an anxiety attack/panic attack?

Panic Attack: a discrete period of intense fear or discomfort with abrupt onset, peaking within minutes, including 4+ symptoms: (1) Palpitations, pounding heart, or accelerated heart rate; (2) Sweating; (3) Trembling or shaking; (4) Shortness of breath or smothering sensation; (5) Choking sensation; (6) Chest pain or discomfort (often mistaken for heart attack); (7) Nausea or abdominal distress; (8) Dizziness, unsteadiness, lightheaded, faint; (9) Chills or hot flashes; (10) Paresthesias (numbness/tingling); (11) Derealization or depersonalization (feeling unreal); (12) Fear of losing control or going crazy; (13) Fear of dying. Panic Disorder: recurrent unexpected panic attacks plus persistent concern about additional attacks or maladaptive behavior changes related to attacks (e.g., avoiding situations). Often co-occurs with agoraphobia (fear of situations where escape may be difficult — open spaces, crowds, public transport). Acute panic attack management: (1) Stay with client; (2) Calm, reassuring voice — speak in short simple sentences; (3) Decrease stimulation — quiet environment, dim lights; (4) Encourage slow breathing — count breaths together, breathe with the client; (5) Grounding techniques — name 5 things you see, 4 you hear, 3 you can touch, 2 you smell, 1 you taste; (6) Reassure that the attack will pass and won't cause harm; (7) Acute medications (benzodiazepines like lorazepam) per orders. Long-term treatment: CBT (especially exposure therapy); SSRIs/SNRIs first-line; benzodiazepines used short-term; relaxation techniques, mindfulness. Caffeine and stimulants worsen anxiety. ER presentation of panic attack often mistaken for cardiac event; appropriate medical evaluation rules out other causes.