A woman in Germany who went to the emergency room because she felt "hysterical" ended up not having a psychiatric disorder as doctors originally suspected. Instead, she had a serious heart condition that could have killed her, according to a new report of her case.
Although the woman's symptoms seemed to be mainly psychological in nature and she was not in any pain, her doctors noticed some key physical clues that led them to the correct diagnosis, and likely saved her life. The case shows that people who have physical illnesses may have no physical pain but instead have psychiatric symptoms, the doctors who treated her wrote in their report.
The 29-year-old woman was a medical student, and was taken by ambulance to the emergency room in June 2014. She said she thought she was having a "nervous breakdown" as a result of having an emotional argument with her boyfriend earlier that day.
By the time she got to the hospital, she was extremely agitated. The woman seemed very anxious and was constantly tossing and turning on the stretcher, said Dr. Thilo Witsch, a cardiologist at the University of Freiburg Heart Center in Freiburg, Germany, and the lead author of the case report, published online Aug. 10 in The Journal of Emergency Medicine.
Her restlessness made it difficult for the staff to get a detailed medical history or do a thorough physical exam, and she was unable to lie still for routine procedures, like taking her blood pressure, Witsch said. Her heart rate was rapid, and she was breathing fast.
In addition to the young woman's anxiety, which she attributed to the stress of fighting with her boyfriend, she described feeling mild numbness and tingling in her hands and feet. But she was not experiencing any pain and had no history of mental illness. [16 Oddest Medical Cases]
The doctors requested she be seen by a psychiatrist because they thought she might have a panic disorder with hyperventilation syndrome, a condition in which a person breathes too heavily or deeply because they feel like they are not getting enough air.
But then, the woman's medical team picked up on some signs that her symptoms were not linked to her emotional distress but instead were a physical health problem.
Witsch said his suspicions were first raised when he noticed a slight bluish tinge to the woman's lips, and how pale her complexion was. She also had a very subtle, mottled skin discoloration on her arms and legs. These symptoms usually result from poor circulation and blood not getting to these parts of the body.
He then received her blood test results, which did not indicate she had hyperventilation syndrome, he said.
Aortic dissection
A closer physical exam showed that the woman had reduced blood flow in both of her arms as well as her legs, and diagnostic testing finally revealed her condition: The woman had an aortic dissection, which is a tear in the inner wall of the aorta, the large blood vessel that routes blood from the heart to other parts of the body, including the limbs and internalorgans, Witsch told Live Science.
Specifically, this woman had a tear in the section of her aorta that was close to her heart, known as a Stanford type A dissection, which is a medical emergency requiring immediate treatment. A substantial percentage of people with this type of aortic dissection die, even with optimal treatment, Witsch noted.
People with this type of aortic dissection usually have intense chest pain, according to the case report.
Ignoring the woman's physical signs because they were masked by psychological symptoms could have had fatal consequences in this case.
"In a very busy emergency room, her physical findings may have easily been overlooked because these patients may get labeled as 'psychogenic,' meaning they have a psychological origin rather than a physical one," Witsch said.
He said it's not unusual for heart conditions to be accompanied by psychiatric symptoms, especially anxiety. This may be due to the activation of the sympathetic branch of the nervous system, which responds to stress and speeds up the heart rate, Witsch said. [11 Tips to Lower Stress]
Aortic dissections are relatively uncommon, and when they do occur, they usually strike much older adults, typically people in their 60s and 70s. When this condition turns up in younger people, there's often a strong genetic predisposition, as doctors eventually learned was the case for this young woman, whose mother had an aortic dissection when she was 40.
Aortic dissections in younger people can also be caused by genetic diseases that weaken the aortic wall, such as Marfansyndrome, Witsch noted.
The woman needed surgery to remove the damaged area of her aorta and replace it with a synthetic tube, called a graft. She spent 19 days in the hospital.
Witsch said he last saw the woman three months after her surgery, in October 2014. She had not had any similar episodes of anxiety, had no medical complaints and was continuing with her medical studies. Because she had been a smoker, she was advised to quit in order to keep her heart healthy for a long time.
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