You go on a home visit to a 35-year-old woman who has recurrent palpitations. She thinks they are anxiety related but her mother is worried that there is something wrong with her heart. She describes an episode two years ago where she suffered marked palpitations when on a busy bus in the summer. She felt she couldn’t breathe but couldn’t exit the bus. Despite pressing the button for the next stop the bus had to travel a further mile and she felt trapped. At one point she believed she was going to collapse.
A few weeks later she felt a wave of panic when a bus passed her or she was near a bus stop. Now she experiences regular attacks, usually when she goes out. During these attacks, she experiences palpitations, starts shaking and sweating and has difficulty breathing. She can only go out with diazepam in her pocket although she rarely uses any. These episodes rarely happen at home.…
