Case Challenge: Panic Attacks or Something Else?
Case Challenge: Panic Attacks or Something Else?
A 48-year-old woman presented complaining of a week of daily episodes of feeling strange, hot, dizzy, with chest tightness followed by severe fatigue, and in 2 cases, there was progression to loss of consciousness. One episode occurred in her doctor's office, where the "patient collapsed in my arms," according to the family practitioner.
Apart from a recent diagnosis of Lyme disease, for which she received a course of doxycycline, the patient had always been in excellent health. There was no history of febrile convulsions, head injury, meningitis, or encephalitis. She took no medications, had no allergies, exercised regularly, did not smoke, rarely drank alcohol, was married, had 2 children, and worked full time. She had no family history of bipolar disorder, schizophrenia, or epilepsy. There was no history of anxiety, depression, recent deaths in the family, or other traumatic psychological events.
The patient was hospitalized for probable cardiac syncope and had an ECG with nonspecific T wave changes. Cardiac Echo and carotid ultrasound were normal. A noncontrast CT of the brain was read as normal (Figure 1). The patient was discharged home with the diagnosis of probable anxiety and panic attacks and prescribed sertraline.
Figure 1. Noncontrast CT scan of brain.
Case Presentation
A 48-year-old woman presented complaining of a week of daily episodes of feeling strange, hot, dizzy, with chest tightness followed by severe fatigue, and in 2 cases, there was progression to loss of consciousness. One episode occurred in her doctor's office, where the "patient collapsed in my arms," according to the family practitioner.
Apart from a recent diagnosis of Lyme disease, for which she received a course of doxycycline, the patient had always been in excellent health. There was no history of febrile convulsions, head injury, meningitis, or encephalitis. She took no medications, had no allergies, exercised regularly, did not smoke, rarely drank alcohol, was married, had 2 children, and worked full time. She had no family history of bipolar disorder, schizophrenia, or epilepsy. There was no history of anxiety, depression, recent deaths in the family, or other traumatic psychological events.
The patient was hospitalized for probable cardiac syncope and had an ECG with nonspecific T wave changes. Cardiac Echo and carotid ultrasound were normal. A noncontrast CT of the brain was read as normal (Figure 1). The patient was discharged home with the diagnosis of probable anxiety and panic attacks and prescribed sertraline.
Figure 1. Noncontrast CT scan of brain.