Unexplained Chest Pain: Could It Be Panic?

Foldes-Busque, Guillaume; Marchand, André; Poitras, Julien; Denis, Isabelle; Fleet, Richard; Diodati, Jean G.; Lessard, Marie-Josee; Pelland, Marie-Ève

doi:10.1037/e620882010-001

Cited by 5 publications

(12 citation statements)

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“…To the best of our knowledge, this is the first large‐scale study to derive and assess the validity of a brief screening aid for panic in ED patients with low‐risk, unexplained chest pain. Although the PSS greatly improves upon the current estimated EP diagnostic rate of less than 10%, 1,3 the sensitivity may still appear to be low. However, the positive and negative predictive values are acceptable because panic is prevalent and not a lethal condition.…”

Section: Discussionmentioning

confidence: 83%

“…Clear physical diagnoses can be attributed to a minority of unexplained chest pain syndromes 2 . Up to 44% of ED patients with unexplained chest pain have either panic disorder or panic attacks 1,3 . For simplicity, we will use “panic” to refer to panic attack and panic disorder in this article.…”

mentioning

confidence: 99%

“…For simplicity, we will use “panic” to refer to panic attack and panic disorder in this article. Panic‐related disorders may be the most common diagnoses associated with unexplained chest pain in ED patients, but remain undiagnosed in 90% of cases 1,3 . Undiagnosed and untreated, panic disorder and panic attacks can become chronic, disabling mental disorders 4 .…”

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confidence: 99%

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Preliminary Investigation of the Panic Screening Score for Emergency Department Patients With Unexplained Chest Pain

Foldes-Busque

Fleet

Poitras

et al. 2011

Academic Emergency Medicine

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Objectives:The objective was to demonstrate the derivation and the preliminary validation of a brief screening score to improve recognition of panic-like anxiety in emergency department (ED) patients with unexplained chest pain.Methods: This cross-sectional study included 507 ED patients with unexplained chest pain randomly assigned to the derivation condition (n = 201) or the validation condition (n = 306). The Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV) acted as the criterion standard for panic diagnosis. Receiver operating characteristic (ROC) curves were used to determine which of the sociodemographic, medical, and questionnaire response variables best predicted the presence of panic-like anxiety in the derivation condition. The selected predictors were entered in a logistic regression analysis to determine variables to be included in the screening score. The predictive validity of the resulting score was evaluated in both conditions. Results:The four-item Panic Screening Score (PSS) identified panic-like anxiety with a sensitivity of 63% (95% confidence interval [CI] = 52% to 73%) and a specificity of 84% (95% CI = 76% to 90%) in the derivation phase. The positive predictive value was 74% (95% CI = 62% to 93%) and the negative predictive value was 76% (95% CI = 68% to 89%). In the validation phase, the sensitivity and specificity were 53% (95% CI = 44% to 62%) and 85% (95% CI = 78% to 89%), respectively. The positive predictive value was 72% (95% CI = 62% to 80%) and the negative predictive value was 71% (95% CI = 65% to 77%).

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Section: Discussionmentioning

confidence: 83%

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confidence: 99%

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confidence: 99%

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Preliminary Investigation of the Panic Screening Score for Emergency Department Patients With Unexplained Chest Pain

Foldes-Busque

Fleet

Poitras

et al. 2011

Academic Emergency Medicine

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“…Anxiety, another measure of NA, has also been linked to higher reports of chest pain among cardiac and non-cardiac populations (25,26). It is though that these relationships may be due to changes in a combination of physiological systems such as the autonomic nervous system, coronary vasculature system including increased microvascular resistance (26) , as well as possibly due to fears associated with having cardiac events (49,50). Patients with a high level of anxiety have a greater tendency to catastrophize somatic symptoms, which has been related to increase pain reporting (51).…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, it should be noted that this is a population who were undergoing exercise stress testing and, as such, individuals with conditions that interfered with their ability to exercise (e.g., severe musculoskeletal pain) would have been ineligible for such a test, and our findings should be viewed in light of this. One important consideration is the broader role of psychological characteristics which may influence chest pain and reporting of chest pain (50,60). Furthermore, patients with CAD are more likely to under-report their emotional distress compare with patients with less severe cardiac condition (61).…”

Section: Discussionmentioning

confidence: 99%

Positive and Negative Affect Is Related to Experiencing Chest Pain During Exercise-Induced Myocardial Ischemia

et al. 2017

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Anxiety Associated With Increased Risk for Emergency Department Recidivism in Patients With Low-Risk Chest Pain

Musey

Patel

Fry

et al. 2018

The American Journal of Cardiology

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Anxiety contributes to the chest pain symptom complex in 30% to 40% of patients with low-risk chest pain seen in the emergency department (ED). The validated Hospital Anxiety Depression Scale-Anxiety subscale (HADS-A) has been used as an anxiety screening tool in this population. The objective was to determine the prevalence of abnormal HADS-A scores in a cohort of low-risk chest pain patients and test the association of HADS-A score with subsequent healthcare utilization and symptom recurrence. In a single-center, prospective, observational cohort study of adult ED subjects with low-risk chest pain, the HADS-A was used to stratify participants into 2 groups: low anxiety (score <8) and high anxiety (score ≥8). At 45-day follow-up, chest pain recurrence was assessed by patient report, whereas ED utilization was assessed through chart review. Of the 167 subjects enrolled, 78 (47%) were stratified to high anxiety. The relative risk for high anxiety being associated with at least one 30-day ED return visit was 2.6 (95% confidence interval 1.4 to 4.7) and this relative risk increased to 9.1 (95% confidence interval 2.18 to 38.6) for 2 or more ED return visits. Occasional chest pain recurrence was reported by more subjects in the high anxiety group, 68% vs 47% (p = 0.029). In conclusion, 47% of low-risk chest pain cohort had abnormal levels of anxiety. These patients were more likely to have occasional recurrence of their chest pain and had an increased risk multiple ED return visits.

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Unexplained Chest Pain: Could It Be Panic?

Cited by 5 publications

References 0 publications

Preliminary Investigation of the Panic Screening Score for Emergency Department Patients With Unexplained Chest Pain

Preliminary Investigation of the Panic Screening Score for Emergency Department Patients With Unexplained Chest Pain

Positive and Negative Affect Is Related to Experiencing Chest Pain During Exercise-Induced Myocardial Ischemia

Anxiety Associated With Increased Risk for Emergency Department Recidivism in Patients With Low-Risk Chest Pain

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