Panic attack triggering myocardial ischemia documented by myocardial perfusion imaging study. A case report
Gastão Luiz Fonseca Soares-Filho1, Claudio Tinoco Mesquita, Evandro Tinoco Mesquita
1Panic and Respiration Laboratory, Institute of Psychiatry, Federal University of Rio de Janeiro, INCT - Translational Medicine (CNPq), Rio de Janeiro, Brazil. galufo@gmail.com.
Insights
Panic attacks can trigger myocardial ischemia in patients with coronary artery disease. Carbon dioxide challenge tests may reveal this link, aiding cardiovascular disease risk assessment.
Area of Science:
- Cardiology
- Psychiatry
- Translational Medicine
Background:
- Chest pain in panic attacks is often misdiagnosed as benign.
- Panic disorder is an independent risk factor for cardiovascular diseases and myocardial infarction.
- Differentiating ischemic from non-ischemic chest pain is crucial.
Observation:
- A case study involving a patient experiencing a panic attack induced by 35% carbon dioxide inhalation.
- Myocardial ischemia was documented during the induced panic attack using myocardial perfusion imaging.
- This highlights the potential for panic attacks to precipitate acute cardiac events.
Findings:
- Panic attacks, a form of mental stress, can induce myocardial ischemia.
- Mechanisms include increased coronary vasomotor tone or sympathetic hyperactivity, leading to heightened myocardial oxygen demand.
- Coronary artery spasm is implicated in panic disorder-associated cardiac ischemia.
Implications:
- Mental stress testing, like the CO2 challenge, can be an alternative method for investigating myocardial ischemia.
- CO2 challenge combined with Sestamibi SPECT offers a translational approach to understanding the interplay between panic disorder and cardiovascular disease.
- This method can improve the application of research findings in clinical practice.
Background:
Chest pain, a key element in the investigation of coronary artery disease is often regarded as a benign prognosis when present in panic attacks. However, panic disorder has been suggested as an independent risk factor for long-term prognosis of cardiovascular diseases and a trigger of acute myocardial infarction.
Objective:
Faced with the extreme importance in differentiate from ischemic to non-ischemic chest pain, we report a case of panic attack induced by inhalation of 35% carbon dioxide triggering myocardial ischemia, documented by myocardial perfusion imaging study.
Discussion:
Panic attack is undoubtedly a strong component of mental stress. Patients with coronary artery disease may present myocardial ischemia in mental stress response by two ways: an increase in coronary vasomotor tone or a sympathetic hyperactivity leading to a rise in myocardial oxygen consumption. Coronary artery spasm was presumed to be present in cases of cardiac ischemia linked to panic disorder. Possibly the carbon dioxide challenge test could trigger myocardial ischemia by the same mechanisms.
Conclusion:
The use of mental stress has been suggested as an alternative method for myocardial ischemia investigation. Based on translational medicine objectives the use of CO2 challenge followed by Sestamibi SPECT could be a useful method to allow improved application of research-based knowledge to the medical field, specifically at the interface of PD and cardiovascular disease.
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