Panic & Plaques: Panic Disorder & Coronary Artery Disease in Patients with Chest Pain

Abstract

Background:The purpose of this systematic review was to identify characteristics of the chest pain associated with the presence of panic disorder, to determine the strength of the association between panic disorder and coronary artery disease (CAD), and to determine the association between panic disorder and known cardiovascular risk factors.Methods: Potential studies were identified via computerized search using MEDLINE and PSYCINFO databases, and review of bibliographies. MeSH headings used included "panic disorder" with "chest pain," "panic disorder" with "coronary disease or cardiovascular disorders or heart disorders," and "panic disorder" with "cholesterol or essential hypertension or tobacco smoking." Studies had to base their diagnosis of panic disorder on criteria from the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, and objective criteria of CAD and risk factors had to be used. Only case-control and cohort studies were included.Results

A 1-year follow-up study of chest-pain patients with and without panic disorder

“…Previous studies of traditional risk factors for CAD in PD patients have also given inconsistent results (11). Furthermore, high self-reported generalized anxiety have in fact been associated with better control of risk factors and more frequent general practitioner visits and subsequently better outcome in terms of cardiac mortality of patients referred for exercise testing (141).…”

“…In PD patients the chest pain is more often atypical as opposed to CAD patients who have more typical chest pain (defined as substernal, exertional and relieved by nitroglycerine) (11). However, PD patients may also have typical chest pain and panic attacks may in fact cause cardiac ischemia in patients with coronary artery disease (40).…”

“…Panic disorder (PD) is the anxiety disorder most frequently associated with chest pain as it occurs in 10 to 60 % of chest pain patients with or without coronary artery disease in cardiology clinics or emergency departments (11)(12)(13)(14). Cross sectional studies of PD in chest pain patients have reported associations with high psychological distress, high rates of comorbid psychiatric disorders, suicidal ideation, work disability, quality of life impairment and high medical utilization (12)(13)(14).…”

Ataques de pânico são realmente inofensivos? O impacto cardiovascular do transtorno de pânico

“…Há evidências na literatura de que a presença de ataques de pânico pode piorar o prognóstico cardiovascular em cardiopatas 13 e, possivelmente, contribuir para a taxa de mortalidade aumentada destes pacientes, uma vez que ataques de pânico, mesmo em pacientes estáveis na condição cardiovascular e em uso de medicação, provocam uma perfusão sanguínea defeituosa 14 . Outra hipótese é que esta ativação pode se tornar perigosa na medida em que taquicardia durante ataques de pânico pode produzir isquemia miocárdica aguda em cardiopatas 15 . Em contraste com estes resultados, em situações cotidianas, parece que ocorre uma depressão da função simpática, aliada à manutenção da função parassimpática, gerando uma predominância parassimpática relativa 11 .…”

Tradução e adaptação transcultural da versão brasileira do Questionário de Ansiedade Cardíaca

“…Mais recentemente, ataques de ansiedade e de pânico também foram relacionados a pior prognóstico em pacientes cardíacos 4,5 . Neste sentido, o reconhecimento de ataques de ansiedade e de pânico em pacientes cardíacos é essencial para evitar complicações sérias 6 .…”