Ayesha: a racing heart on the bus

The case (fictional)

Ayesha is a 27-year-old bank officer in Karachi who lives with her parents, her brother and his family. Seven months ago her father collapsed at home with a heart attack. She rode with him to hospital in the back of a rickshaw, holding his hand while he struggled to breathe. He recovered after a stent was fitted.

About six weeks later, on a hot and crowded bus to work, Ayesha suddenly felt her heart pounding, her chest tighten and her hands tingle. She was sure she was having a heart attack and got off at the next stop. Since then she has had similar episodes two or three times a week, each building to a peak within a few minutes. Two ECGs and blood tests at a private clinic were normal, but she says "the machines can miss things".

She now takes a taxi to work, which costs much of her salary, avoids climbing stairs quickly and checks her pulse many times a day. She has stopped drinking tea. Her mother keeps a bottle of water and a remedy from the local hakeem in her bag "just in case". Relatives say it is nazar, the evil eye, or that she is "too sensitive, like her nani".

She sleeps reasonably well, still enjoys playing with her nieces and would like to return to her evening Quran class, which she stopped because it meets on the third floor. She has no history of mental health care, does not drink or use drugs, and denies any thoughts of harming herself. Her manager has been understanding so far.