The patient is a 45-year-old female who tells me she was on vacation in Cape Cod last week. Toward the end of her vacation, she was sitting on the beach with her family. She states that she had a lunch of a humus sandwich and some chips, which is usual for her. She was sitting relaxing, and had onset of 3/4 substernal chest pressure that lasted for about 30 seconds and then went away, but was followed by a feeling as though there was a flushing that came up her body into her arms through her head. She felt as though her heart was racing, she felt lightheaded, almost like she perhaps she would pass out. She did not have any vertiginous type symptoms. She felt "woozy". She discussed it with her husband and they decided to give it some time and she went and sat in the cool water, but still just did not feel right. They decided to get up and walk back through the dunes, but she was just feeling too lightheaded and woozy and they decided to call 911. In the ambulance, her pulse ranged from 120 to 130, but apparently was regular. She, in the emergency room, had a normal EKG, negative troponin, negative CMP, except for a slightly low calcium of 8.2, normal TSH, normal CBC. She felt better after some IV fluids and thought that would be the end of it after she was discharged. That night, however, she once again felt similar symptoms, including the flushing feeling that came up her arms, she was not hungry, she states these flushing episodes occurred five or six times in a 10 minute period. She called the emergency room again and they wanted her to come back, but she decided just to go to bed. The next day, she was very fatigued and took four or five naps throughout the da...
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...ted on a day at the beach after being on vacation for a week. She was not eating her usual diet on vacation. Question whether these might be panic attacks set off by the recent stressors including a fight with her teenage son and her father-in-law 's diagnosis. Question whether this might be reflux that cause the chest pain followed by panic attacks. Question underlying viral etiology. At this point, we will go ahead and order a Holter monitor. If she does continue to have palpitations, will do a stress echocardiogram given her chest pain that she had. I did ask patient to consider trying Prilosec over the counter for two weeks. She will continue the baby aspirin until her heart studies come back. Calcium level was low and this will be repeated along with a phosphorus. We will also check a Lyme titer. At this point, we will follow up with patient by phone.
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