Unexplained chest pain in the ED: could it be panic?
Guillaume Foldes-Busque1, André Marchand, Jean-Marc Chauny
1Department of Psychology, Université du Québec à Montréal, Quebec, Canada. guill.foldesbusque@videotron.ca
The American Journal of Emergency Medicine
|September 10, 2010
Summary
Paniclike anxiety affects 44% of emergency department patients with unexplained chest pain. This common condition is frequently missed by emergency physicians, highlighting a critical diagnostic gap.
Area of Science:
- Emergency Medicine
- Psychiatry
- Clinical Psychology
Background:
- Unexplained chest pain (UCP) is a common reason for emergency department (ED) visits.
- Paniclike anxiety is a potential underlying cause of UCP, yet its prevalence and recognition in ED settings are not well-established.
Purpose of the Study:
- To determine the prevalence of paniclike anxiety in ED patients presenting with UCP.
- To compare the characteristics of UCP patients with and without paniclike anxiety.
- To assess the rate at which emergency physicians identify panic in these patients.
Main Methods:
- A structured interview, the Anxiety Disorders Interview Schedule (ADIS-IV), was used to diagnose paniclike anxiety.
- Self-report questionnaires assessed anxious and depressive symptoms.
- Patient medical records provided sociodemographic and medical information.
Main Results:
- Paniclike anxiety was prevalent in 44% of the 771 UCP patients studied.
- Patients with paniclike anxiety had higher rates of psychiatric disorders (63.4%) and suicidal thoughts (21.3%) compared to those without.
- Emergency physicians diagnosed panic in only 7.4% of identified cases.
Conclusions:
- Paniclike anxiety is a common comorbidity in emergency department patients with unexplained chest pain.
- There is a significant underdiagnosis of paniclike anxiety in this patient population within the ED setting.
- Improved screening and diagnostic approaches are needed for paniclike anxiety in UCP patients.
More Related Videos
Related Concept Videos
01:27Panic Disorder
Panic disorder is an anxiety disorder characterized by recurrent and sudden minutes-long episodes of intense fear, known as panic attacks. These attacks may feel like heart attacks and often happen without warning or a specific cause. They can include symptoms such as rapid heart rate, shortness of breath, chest pain, trembling, sweating, dizziness, and a sense of helplessness. During a panic attack, individuals may feel as though they are experiencing a heart attack or are in a...
01:29Angina III: Clinical Manifestations and Assessment
Angina manifests as chest pain, tightness, or squeezing discomfort typically located behind the breastbone. It can radiate to the neck, jaw, shoulders, and inner aspects of the upper arms, most commonly the left arm. Patients may experience shortness of breath, fatigue, profuse sweating, dizziness, indigestion, heartburn, palpitations, anxiety, and vomiting as accompanying symptoms. This pain often lasts a few minutes and is triggered by physical exertion, emotional stress, heavy meals, or cold...
01:30Coronary Artery Disease III: Clinical Manifestations
Coronary Artery Disease (CAD) is a primary health risk worldwide, leading to significant morbidity and mortality. The condition arises from the buildup of atherosclerotic plaques within the coronary arteries, resulting in diminished blood supply to the heart muscle.The clinical manifestations of CAD vary widely, from asymptomatic stages to severe, life-threatening conditions. Understanding these manifestations is crucial for early diagnosis and effective management.Angina Pectoris: The Warning...
01:30Angina I: Introduction
Definition and Symptoms: Angina (angina pectoris) is chest pain or discomfort caused by myocardial ischemia, which occurs when the heart muscle receives insufficient oxygen-rich blood. It typically manifests as pressing, squeezing, or crushing sensations in the chest and may radiate to the shoulders, arms, neck, jaw, or back.Primary Cause: In a healthy state, the coronary arteries can dilate (widen) to increase blood flow and meet the increased oxygen demand during physical activity or...
01:27Pneumothorax-II
Pneumothorax is a medical condition defined by the buildup of air in the pleural space between the lungs and the chest wall. This accumulation of air can lead to partial or complete lung collapse, resulting in a range of clinical manifestations. Understanding the clinical presentation and effective management strategies is crucial for healthcare professionals in providing timely and appropriate care to individuals with pneumothorax.
Clinical Manifestations:
Clinical Manifestations:
01:27Angina II: Classification
Angina, also known as angina pectoris, is a chest pain resulting from diminished blood flow to the heart muscle and is often a symptom of coronary artery disease. Angina presents several variants with distinctive attributes, etiologies, and therapeutic approaches. The main types of angina include stable, unstable, variant (Prinzmetal's), microvascular, intractable, and silent ischemia.Stable angina is caused by atherosclerosis, which leads to the formation of plaques that narrow the coronary...