What is the most likely diagnosis for a 47-year-old man experiencing episodes resembling heart attacks, associated with palpitations and sweating?

The symptoms described—episodes resembling heart attacks accompanied by palpitations and sweating—are characteristic of panic disorder. This condition often manifests with sudden and intense episodes of fear or discomfort that peak rapidly, resulting in physical symptoms that can be mistaken for those of a heart attack, such as chest pain, palpitations, and sweating. During a panic attack, individuals may also experience feelings of impending doom or loss of control.

In panic disorder, these episodes can occur unexpectedly or be triggered by specific situations, leading to significant distress and often resulting in the individual avoiding situations where they fear a panic attack might occur. The acute nature of these symptoms, along with the absence of other identifiable medical causes, supports this diagnosis.

The other options, while they may present with some overlapping symptoms, typically do not primarily involve the intense, acute physical symptoms or the specific nature of panic attacks seen in this scenario. Adjustment disorders and generalized anxiety disorder may have different symptom profiles and durations, while acute stress reaction is generally related to a specific traumatic event and has a different clinical presentation. Therefore, the diagnosis that aligns best with the described symptoms is panic disorder.