<s>[INST] I m 20 days smoke free, and for the past 3 days I started experiencing chest tightness, mild difficuly breathing, dizziness, and intermittent skipping heart beats. I also have Type 1 diabetes and have had it for 20 years. I have experinece with anxiety and this is completley different. I saw a walk in clinic dr., and he said it is probably anxiety. I advised him this is very different. Ia m wondering if I should seek ER care [/INST] Hi welcome to Chat Doctor... According to history here first cardiac cause has to be ruled out by following investigation.....1. Blood pressure monitoring 2.EKG 3. Echo (if needed)According to cause treatment given ... After ruling out cardiac cause, investigate for resp cause by digital chest x-ray and spirometry ..... If no significant cardiac and resp cause present than yes these type of symptoms can occur by anxiety induce panic attack... Hope your concern solved. Advise : consult physician Take care .... </s>