A 26-year-old woman visits to the emergency department for a follow-up visit for chest pain. The chest pain came on while she was driving and she felt an abrupt onset of a pounding heart, a sense of choking and breathlessness, and a fear she would die. She called emergency services from her car and was carried by an ambulance to the emergency department. By the time of arrival, her symptoms had improved. Blood pressure was 118/70, pulse was 70.
ECG was normal. TSH, CBC, and electrolytes were normal. Urine drug screening was negative. She has not driven since the incident and she requests a work release from the doctor. She has never been diagnosed with a psychiatric illness, but she reports she frequently worries “about everything, but especially driving”.