Abstract
A 67-year-old woman presented to the emergency department with left sided chest tightness and left arm pain with paresthesia. Over the past 6 years, she had a circannual pattern of stereotyped attacks occurring predictably during the winter solstice, lasting approximately 6 weeks. The majority of attacks would abruptly awaken her from sleep, with excruciating left sided chest, jaw, arm, back, torso, and abdominal pain. Each episode lasted 1 to 2 hours untreated and was accompanied by paresthesias that would begin over the left side of her chest and march over 10 minutes to involve her left face, then arm and hand, and finally her medial left thigh. During each of the one to three daily episodes, the patient experienced restlessness and felt the need to pace. On previous emergency visits, the patient made the observation that 100% oxygen provided symptomatic relief faster than the untreated duration of …
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