A young woman sought psychological services after her cardiologist referred her for stress management and treatment of “heart attack” symptoms. This 36-year-old woman had the world by the tail. Marketing director for a local high-tech firm, she was in line for promotion to vice president. She drove a new sports car, traveled extensively, and was socially active. Although on the surface everything seemed fine, she felt that, “the wheels on my tricycle are about to fall off. I’m a mess.” Over the past several months she had attacks of shortness of breath, heart palpitations, chest pains, dizziness, and tingling sensations in her fingers and toes. Filled with a sense of impending doom, she would become anxious to the point of panic. Every day she awoke with a dreaded feeling that an attack might strike without reason or warning. On two occasions, she rushed to a nearby hospital emergency room fearing she was having a heart attack. The first episode followed an argument with her boyfriend about the future of their relationship. After studying her electrocardiogram, the emergency room doctor told her she was “just hyperventilating” and showed her how to breathe into a paper bag to handle the situation in the future. She felt foolish and went home embarrassed, angry and confused. She remained convinced that she had almost had a heart attack. Her next severe attack occurred after a fight at work with her boss over a new marketing campaign. This time she insisted that she be hospitalized overnight for extensive diagnostic tests and that her internist be consulted. The results were the same–no heart attack. Her internist prescribed a tranquilizer to calm her down.


This case study revolves around a young woman who sought psychological services due to symptoms related to stress and a perceived heart attack. Despite her successful professional and personal life, she experienced episodes of shortness of breath, heart palpitations, chest pains, dizziness, and tingling sensations in her fingers and toes. These physical symptoms were accompanied by a sense of impending doom and anxiety, leading her to seek medical attention on multiple occasions. However, her medical tests consistently showed no evidence of a heart attack.

Context of the Case Study

The young woman in this case study is a 36-year-old marketing director for a high-tech firm. Her high-stress job, combined with her active social life and personal ambitions, suggest a high level of responsibility and pressure. It is worth noting that her cardiologist referred her for stress management and treatment, indicating recognition of the potential psychological underpinnings of her symptoms.

Initial Medical Experiences

The first incident occurred after an argument with her boyfriend. Following this disagreement, she experienced alarming symptoms and rushed to the emergency room fearing a heart attack. However, the doctor diagnosed her as “just hyperventilating” and instructed her on breathing techniques using a paper bag. While this explanation alleviated her immediate fears, she still felt embarrassed, angry, and confused about her experience. She continued to believe that she had almost suffered a heart attack.

The second incident, which took place at work after a disagreement with her boss, led her to demand overnight hospitalization and extensive diagnostic tests, including consultation with her internist. Once again, the results showed no evidence of a heart attack. Instead, her internist prescribed a tranquilizer to help manage her anxiety.

Psychological Explanation

The symptoms experienced by the young woman in this case study are consistent with a panic disorder, a type of anxiety disorder characterized by recurring panic attacks. Panic attacks are sudden and intense episodes of fear that often include physical symptoms such as rapid heartbeat, shortness of breath, chest pain, dizziness, and tingling sensations. These attacks are usually accompanied by a profound sense of impending doom or a fear of losing control.

The young woman’s panic attacks seem to be triggered by stressful situations, such as arguments or conflicts in her personal or professional life. This suggests that there may be underlying psychological factors contributing to her symptoms. It is possible that her high-stress lifestyle, coupled with her drive for success and perfectionism, has led to an accumulation of stress and anxiety. These factors may have predisposed her to experiencing panic attacks as a way of coping with the overwhelming demands of her life.


This case study highlights the complex interplay between psychological and physical symptoms. The young woman’s experience of panic attacks, characterized by physical symptoms resembling a heart attack, underscores the importance of considering psychological factors in the assessment and treatment of medical conditions. In this case, the woman’s medical tests consistently showed no evidence of a heart attack, pointing towards the need for a psychological evaluation and intervention to address her panic disorder. By understanding the psychological underpinnings of her symptoms and implementing appropriate stress management strategies, the young woman can improve her quality of life and reduce the occurrence of panic attacks.