A Patient With a Misdiagnosed Psychiatric Disorder (Part 3)

Apr 30, 2026   |  Bruce Sheldon Stambler, MD, FACC
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A 45-year-old woman who lives alone in a rural area experiences sudden onset of palpitations associated with dyspnea, profuse sweating, paresthesia in both hands, and a rapid pounding sensation in her neck after an argument with a neighbor. She has had similar symptoms for the past several years that usually last <5 min. During one episode, her symptoms resolved after bearing down. Approximately 6 months ago, an episode did not resolve on its own and required her to drive to the local emergency department (ED), approximately 20 min away, where she was found to be in sinus tachycardia. She was advised to follow up with her primary care provider (PCP). At her recent yearly visit with her PCP, she reported these symptoms, noting that her episodes often occur in association with emotional distress and worsen her anxiety. She was prescribed sertraline to treat a panic disorder.

During her current episode, her home blood pressure (BP) device indicates that her BP is 105/76 mm Hg and heart rate (HR) is 145 bpm. She repeatedly tries Valsalva maneuvers, including lying down and raising her legs after straining, with no success. She prepares a large basin full of ice water and submerges her face in it. She shivers but her symptoms persist. She becomes lightheaded and has a sense of impending doom. Frustrated and increasingly anxious, she calls 911, concerned that this episode may be life-threatening.

Figure 1

Figure 1

If this patient were to have a recurrent symptomatic episode with an ECG recording such as the one shown in Figure 1 (above), which one of the following would not be an appropriate management option to review with her as part of a shared decision-making discussion?

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