# Misdiagnosis of Supraventricular Tachycardia as Panic Attacks: A Case Report Highlighting the Importance of Accurate Cardiovascular Evaluation

## TL;DR

A woman misdiagnosed with panic attacks was found to have a heart condition, highlighting the need for thorough cardiovascular evaluations.

## Contribution

Highlights the importance of cardiovascular evaluation in cases where symptoms mimic psychiatric disorders.

## Key findings

- A patient with unexplained panic attacks was diagnosed with supraventricular tachycardia (AVNRT) after multiple misdiagnoses.
- Intravenous diltiazem successfully treated the patient's SVT, resolving her symptoms.
- The case emphasizes the need to consider cardiac arrhythmias in patients with anxiety-like symptoms.

## Abstract

Palpitations are a common symptom with diverse etiologies, ranging from benign to life-threatening conditions. One of the challenges in clinical practice is differentiating between cardiac arrhythmias and psychiatric disorders, such as panic attacks, as their symptoms often overlap. This case report presents a 45-year-old female who presented with a history of unexplained panic attacks. She was initially diagnosed with panic disorder. However, she was refractory to all anti-anxiolytic trials. The patient had multiple emergency room (ER) visits for similar episodes, during which all cardiac workups, including electrocardiogram (ECG) and echocardiograms (echo) at a different facility, were negative according to the patient. During an ER visit for a similar episode at Wyckoff Heights Medical Center, she was found to have supraventricular tachycardia (SVT), specifically atrioventricular nodal reentrant tachycardia (AVNRT). The most prominent evidence in her presentation was a sustained heart rate of 217 beats per minute, which ultimately led to performing an ECG. The findings of the ECG were consistent with a diagnosis of narrow complex tachycardia suggestive of SVT. The patient was successfully treated with intravenous diltiazem, and her symptoms resolved promptly. This report underscores the importance of considering cardiac arrhythmias in patients presenting with palpitations, anxiety, and chest discomfort, which may mimic psychiatric conditions even in the absence of abnormalities on initial cardiac workup at presentation. Timely and accurate diagnosis is crucial to avoid delays in appropriate treatment and prevent unnecessary psychiatric interventions. The case highlights the value of thorough cardiovascular evaluation, particularly in patients with recurrent or unexplained episodes of palpitations, as well as the role of advanced diagnostic techniques in improving diagnostic accuracy.