An Athletic 37-Year-Old Woman With Suspicious Panic Attacks

Thomas J. Hemingway, MD

Disclosures

September 01, 2020

Editorial Note: The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.

Background

A 37-year-old woman with a history of anxiety disorder presents to the emergency department (ED) with what she describes as a panic attack. She reports chest-pounding palpitations, racing heart rate, severe dyspnea, and lightheadedness. She is beginning to feel some chest heaviness. She has a several-year history of these intermittent symptoms, which she ascribes to panic attacks. These paroxysms often last for 10-15 minutes and spontaneously subside before her arrival to the ED.

In the past, she had an extensive but essentially normal cardiac workup, which included ECG, exercise treadmill test, 24-hour Holter monitor, and echocardiography. She notes that she was asymptomatic at the time that the studies were being conducted. Her primary care provider diagnosed her with anxiety disorder with panic attacks and prescribed a selective serotonin reuptake inhibitor (SSRI).

Despite treatment, she has had several episodes per year. They do not appear to be associated with anything in particular. Her current episode began while she was playing water polo with her community league team. To her surprise, it did not spontaneously subside. She began to feel drained of her usual energy and stamina and thought that she would pass out. She immediately got out of the pool and was quickly rushed to the ED by her friends.

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