Case Western Reserve University School of Medicine, Cleveland, Ohio eberko@metrohealth.org
The authors reported no potential conflict of interest relevant to this article.
Pharmacologic and/or psychotherapeutic interventions are effective for most patients. But first, you must rule out organic causes of the patient’s symptoms.
Lorna D* was seen by her primary care physician (PCP) as follow-up to a visit she made to the emergency department (ED). The 37 year old had gone to the ED 4 times in the previous year. Each time she presented with tachycardia, dyspnea, nausea, numbness in her extremities, and a fear that she was having a heart attack. In spite of negative work-ups at each visit (electrocardiogram, cardiac enzymes, complete blood count, toxicology screen, Holter monitoring), Ms. D was terrified that the ED doctors were missing something. She was still “rattled” by the chest pain and shortness of breath she had experienced. Mild symptoms were persisting and she was worried that she would have a heart attack and die without the treatment she believed she needed.
How would you proceed with this patient?
*The patient’s name has been changed to protect her privacy.
