A 36-year-old woman with a history of anxiety disorder presents to the emergency department with a sensation of chest-pounding palpitations, chest heaviness, racing heart rate, severe dyspnea, and lightheadedness. She has a several-year history of these intermittent symptoms, which she mentioned as "panic attacks." These symptoms often last for 10-15 minutes and spontaneously subside before her arrival to the ED. This time, it did not subside even after a long time. In the past, she had an extensive cardiac workup, which included ECG, exercise treadmill test, 24-hour Holter monitor, and echocardiography.
Surprisingly, 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). Physical examination Her heart rate is irregular and…
