Your heart takes off out of nowhere. Chest tight, can't catch your breath, a wave of dread that something is terribly wrong. The chart says panic disorder—and often that's exactly right. But sometimes it isn't.

In the inaugural episode of "The Psych Consult: Second Opinion," host Claire Brandon, MD, a consultation-liaison psychiatrist in New York City, sits down with interventional cardiologist Lara Oboler, MD, to unpack how conditions like supraventricular tachycardia (SVT) and postural orthostatic tachycardia syndrome (POTS) can look almost identical to a panic attack—and how to tell them apart before a patient spends years chasing the wrong diagnosis.

They walk through a real-world case: a 28-year-old woman sent home from the ER again and again with "it's just anxiety," until an event monitor finally caught her heart rate spiking to 180 beats per minute. Oboler explains the clues that should make any clinician pause—heart rate that snaps on and off instead of ramping up, rates north of 150 to 180 bpm, and whether P waves show up on the monitor.

You will also learn simple bedside tricks patients can try at home—like bearing down or a carotid massage—that will break an SVT episode but do nothing for a panic attack, plus a "poor man's tilt table test" Oboler runs right in her office to screen for POTS without an immediate cardiology referral.

Then there's the twist: fixing the arrhythmia doesn't always fix the fear. The two doctors talk candidly about the anxiety, hypervigilance, and even medical PTSD that can linger long after a cardiac diagnosis is treated—and why psychiatric and cardiac care need to run side by side, not one after the other.

Whether you are a psychiatrist, a therapist, or someone who's ever Googled "is my anxiety actually my heart," this conversation is the curbside consult you wish you'd had sooner.
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