Diagnostic overshadowing

Cardiac pathology mimicking psychiatric illness and psychiatric illness mimicking cardiac pathology.

The most perilous scenario for the psychiatrist is diagnostic overshadowing.

This occurs when a clinician encounters a patient with a known psychiatric history and reflexively attributes all new acute symptoms to their mental illness, failing to investigate a life-threatening medical cause.

Give us the classic example from the cardiovascular system.

A psychiatric patient presents to the emergency department with acute onset of severe anxiety, dyspnea, palpitations, and a sense of impending doom following a long-haul flight.

They have no prior psychiatric history.

To avoid the trap of diagnostic overshadowing, which life-threatening medical masquerader must be ruled out immediately? A, Brugada syndrome.

B, pulmonary thromboembolism.