Several years ago I was diagnosed with generalized anxiety disorder with panic attacks that occured after a hypertensive crisis with syncope and trip to the ER. Ive been to the ER several times due to the variety of symptoms that can be produced by anxiety and panic. There are times when I just can t trust that the symptoms are not cardiac related. Each time to my embarrassment my ekg, troponin, chest x-ray, stress echo all come back unremarkable. Just this last week I went to the ER because out of nowhere I felt what I can only describe as a heavy thump and pause followed be a brief feeling of syncope then tachycardia. Ive worn the King of hearts monitors, had 24 hour urine test, stress echos etc. in an attempt to find what I still believe is some sort of conduction disturbance. I know I have anxiety, I know I have panic attacks and I know that anxiety/panic can cause a remarkable array of symptoms. The ironic part is that I am an ER RN. My wife who is also and ER RN has felt the irregular thump....we know its there but we can never record it. My current medications are HCTZ, metoprolol, amlodipine, ativan (prn), xanax (prn). Today my PCP kindly and patiently suggested buspar. I have taken escitolapram in the past which did indeed quell my anxiety and panic attacks...so much that I quit all benzos. The ssri side effects were too much. This is debilitating. I cant leave the thought alone about having something wrong cardiac wise even though my training and all testing tells me otherwise. Is buspar a sound alternative? Should I press harder and ask for a cardiology consult? I have seen that amlodipine though somewhat rare can cause strong palpitation and irregular heart beats and asked my PCP to start decreasing the dose to get me off of it. To me it is worth a try. The issue is too the point of interfering with quality of life. Im not sure what to do. I feel like an idiot recalling all the times I talked a patient down, comforted and reassured them with their panic and anxiety attacks but have found no ability to convince myself. I have also been researching dysautonomia. There are many circumstances that have occured that fit into a possible diagnosis that I have not mentioned. Any thoughts?