A 52-Year-Old Woman Experiencing Panic Attacks

Introduction. A 52-year-old woman has been experiencing sporadic panic attacks for several months that are not related to any specific behaviors or exposures. The attacks are characterized by a racing and strong pounding heart rate, profuse sweating out of proportion to activity or ambient temperature, and accompanying headaches.

Patient history. Although the patient's attacks were initially attributed to her being perimenopausal, when the severity of the attacks continued, she was prescribed anti-depressants, which provided no clinical effect and were discontinued. Blood pressure readings were elevated at recent visits. Indeed, some readings reached the 200/120 mm Hg range, which was surprising given that there was no antecedent history of hypertension. She was then referred for further diagnostic evaluation. The patient’s family history is negative for diabetes or hypertension. She is married with two grown children and both pregnancies and deliveries were without complication. She currently takes no medications, but anti-hypertensives are being considered for this new labile hypertension.

Physical examination. Her physical examination showed that she was afebrile, with a pulse of 92 beats per minute. Her blood pressures, taken several times during the visit, were in the 165/105 mm Hg range. The remainder of the examinations fell within normal ranges.

Diagnostic evaluation. Routine laboratory studies demonstrated a complete blood count within normal range. Her metabolic panel with blood glucose 99/mg/dl and hemoglobin A1C 5.1 were within normal ranges as well. Finally, her biochemical profile was within normal range. An electrocardiogram was negative for left ventricular hypertrophy. She reiterated during the interview that her feelings of panic only occurred in the setting of the pounding pulse and sweating and never at any other times.