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

Thomas J. Hemingway, MD


September 01, 2020

Physical Examination and Workup

Upon initial physical examination, the patient is a young woman in athletic condition who appears pale and diaphoretic. In general, she is somewhat lethargic and in mild respiratory distress. Her heart rate is irregular and tachycardic, ranging from 170 to 300 beats/min. Her blood pressure is 80/46 mm Hg. Her respiratory rate is 18 breaths/min, with an oxygen saturation of 99% on 2 L. Her heart sounds include an S1 and S2, with an irregular tachycardic rhythm. The patient's lung sounds are clear to auscultation bilaterally. Her extremities are free of edema, but they are cool and with faint distal pulses.

The initial ECG reveals an irregular, wide complex tachycardia at a rate of 224 beats/min (Figure 1). Because of her altered mentation and significant hypotension, the American Heart Association's (AHA's) Advanced Cardiac Life Support (ACLS) algorithm[1] is initiated by the ED staff, and a synchronized cardioversion is performed. The patient converts to a normal sinus rhythm at a heart rate of 58 beats/min. A repeat 12-lead ECG is obtained (Figure 2).

Figure 1.

Figure 2.


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