A 22-year-old patient presents to the emergency room after a motor vehicle collision. The patient had airbag deployment and was wearing his seatbelt. The patient was hit on the passenger side by a vehicle going about 40 miles per hour. Extraction time was 5 minutes and the patient was ambulatory on the scene. No loss of consciousness was reported and the patient denies hitting their head. The patient is complaining of chest pain.

An EKG shows sinus tachycardia and the patients cardiac markers come back negative. The patient states, “I know what is happening to my body and I am having a heart attack! They hit me so hard that my heart stopped working! That is the only explanation for this pain in my chest! My grandfather died of a heart attack, so check again. Isn’t there another test we can do to make sure?” Despite reasoning with the patient and informing him his chest hurts from the seatbelt restraining him during the car accident, this patient is convinced he is having a heart attack.

You administer 2 mg IV Ativan and the patient is calming down, they report that they are still having a heart attack and want to go to cath-lab to be checked out. You explain to the patient that cath-lab is used for people having blockages in their cardiovascular system and would not be indicated for them since they are not having any ischemia in the heart. The patient insists that there has to be something wrong with their heart and that something needs to be done.