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Microvascular angina and panic disorder
P P Roy-Byrne1, P Schmidt, R O Cannon
1Department of Psychiatry and Behavioral Sciences, University of Washington Medical School, Seattle.
Abstract:
Recent cardiac studies have suggested that patients with chest pain and angiographically normal coronaries have "microvascular angina" (MVA). In contrast, prior psychiatric studies have shown that some of these patients have panic disorder (PD). We compared the clinical and psychologic characteristics of fifteen patients with MVA and fifteen patients with panic disorder (PD), and examined response to lactate infusion in a subgroup of MVA patients. Although 40 percent of MVA patients met criteria for PD and had chest pain following lactate infusion, there were psychologic and symptomatic differences between the MVA and PD groups. These results reflect either co-morbidity of MVA and PD in some patients or two types of MVA, one of primary cardiac origin and one a centrally mediated epiphenomenon of the increased autonomic arousal seen in PD.
Insights
Patients with microvascular angina (MVA) and panic disorder (PD) share symptoms but differ psychologically. Some MVA patients exhibit PD traits, suggesting co-morbidity or distinct MVA origins.
Area of Science:
- Cardiology
- Psychiatry
- Psychosomatic Medicine
Background:
- Chest pain with normal coronary arteries is often diagnosed as microvascular angina (MVA).
- Some patients with MVA also exhibit characteristics of panic disorder (PD).
Purpose of the Study:
- To compare clinical and psychological features of MVA and PD patients.
- To investigate the response to lactate infusion in MVA patients.
Main Methods:
- Comparative analysis of 15 MVA patients and 15 PD patients.
- Psychological assessments and clinical evaluations.
- Lactate infusion challenge in a subset of MVA patients.
Main Results:
- 40% of MVA patients met PD criteria and experienced chest pain post-lactate infusion.
- Despite overlap, significant psychological and symptomatic differences were observed between MVA and PD groups.
- Lactate infusion triggered chest pain in some MVA patients, consistent with PD responses.
Conclusions:
- Findings suggest potential co-morbidity between MVA and PD.
- Results may indicate two distinct MVA types: primary cardiac or a central phenomenon linked to PD-related autonomic arousal.