<![CDATA[Massive pulmonary embolism (PE) is a life-threatening cardiovascular emergency associated with significant morbidity and mortality, particularly when diagnosis is delayed because of atypical clinical presentation. Young adults may present with nonspecific symptoms mimicking psychiatric disorders, leading to diagnostic uncertainty and delayed intervention. We report the case of a 29-year-old male presenting with progressive dyspnea, palpitations, chest tightness, dizziness, hyperventilation, and severe anxiety symptoms initially diagnosed as panic attacks during repeated emergency department visits. Despite symptomatic treatment with anxiolytic medication, the patient experienced worsening respiratory distress and hemodynamic instability. Electrocardiography demonstrated sinus tachycardia, S1Q3T3 pattern, incomplete right bundle branch block, and anterior T-wave inversion suggestive of acute right ventricular strain. Laboratory investigations revealed elevated D-dimer, troponin-I, and brain natriuretic peptide levels. Transthoracic echocardiography demonstrated severe right ventricular dilatation, pulmonary hypertension, septal flattening, and McConnell’s sign. Computed tomography pulmonary angiography confirmed extensive bilateral pulmonary embolism involving both main pulmonary arteries with evidence of right ventricular strain. Systemic thrombolytic therapy followed by anticoagulation resulted in significant clinical improvement. This case emphasizes the importance of maintaining high clinical suspicion for pulmonary embolism in young adults presenting with unexplained anxiety-like cardiopulmonary symptoms to prevent delayed diagnosis and potentially fatal outcomes.]]>
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