Author: Ishani Mehta, Joanne Ollerton / Editor: Sarah Edwards / Codes: MHC6, MHP3, SLO1 / Published: 01/06/2026
A 33-year-old man presents to the Emergency Department (ED) after his GP identifies a potassium level of 6.6 mmol/L. He reports a three-year history of intermittent dizziness, “blood rushing” to his head and chest tightness. These episodes occur three to four times per year and last seconds to minutes. His most recent episode was two months ago.
He describes dizziness building over 10 seconds, followed by central chest tightness radiating to both arms, rated 4/10, worse on inspiration and not exertional. He also reports bilateral arm paraesthesia during the episodes which then fully resolves. On detailed questioning, each episode directly follows cannabis use; he smokes approximately five joints daily and has done so for over 20 years.
His background includes haemochromatosis, emotionally unstable personality disorder with auditory and visual hallucinations, mixed anxiety and depression, previous alcohol and cocaine misuse and right hamstring surgery in April 2025 resulting in reduced mobility. He lives in supported accommodation.
On examination, observations are stable with a NEWS of 0 throughout attendance. Cardiovascular examination is unremarkable. Respiratory examination reveals an inspiratory wheeze without crackles. ECG shows sinus rhythm; previously noted tall T waves normalise on repeat tracing. Repeat blood tests in ED demonstrate potassium 4.6 mmol/L with normal Full Blood Count (FBC), Urea and Electrolytes (U&Es), C- Reactive Protein (CRP), Liver Function Tests (LFTs), troponin and D-dimer. A Chest X-ray is requested to exclude a lower respiratory tract infection. The patient is medically well but distressed by recurring symptoms.
The working diagnosis is psychosomatic disorder.
2 responses
Good review
Great Revision