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Panic disorder, chest pain and coronary artery disease: literature review
R P Fleet1, G Dupuis, A Marchand
1Institut de Cardiologie de Montréal, Québec.
Insights
Panic disorder affects over 30% of patients with chest pain and minimal coronary artery disease (CAD). Early recognition and treatment are crucial to prevent disease progression and reduce healthcare costs.
Area of Science:
- Cardiology
- Psychiatry
- Medical Research
Background:
- Chest pain is a common symptom with various potential causes.
- Coronary artery disease (CAD) is a primary concern, but other conditions can mimic cardiac symptoms.
- Panic disorder is a psychiatric condition that can present with physical symptoms similar to cardiac events.
Purpose of the Study:
- To investigate the link between panic disorder, atypical chest pain, and coronary artery disease (CAD).
- To highlight the prevalence of panic disorder in patients presenting with chest pain to cardiologists.
- To underscore the importance of recognizing and treating panic disorder in this population.
Main Methods:
- Conducted literature searches of PSYCHLIT and MEDLINE databases.
- Utilized keywords related to panic disorder and chest pain.
- Reviewed 38 articles published between January 1973 and June 1993.
Main Results:
- Panic disorder is identified in at least 30% of patients with chest pain and minimal or no CAD.
- Panic disorder can coexist with diagnosed CAD.
- Undiagnosed panic disorder can lead to increased disease progression, disability, and higher medical costs.
Conclusions:
- Cardiologists should be alert to panic disorder symptoms in patients with chest pain.
- Referral to mental health professionals is recommended for assessment and treatment of suspected panic disorder.
- Future research should employ prospective, randomized, and blinded methodologies to accurately determine panic disorder prevalence in cardiology patients.
Objective:
To examine the association among panic disorder, atypical chest pain and coronary artery disease (CAD). This article's purpose is to inform cardiologists of the prevalence of psychiatric disorders, primarily panic disorder, among patients consulting for chest pain. Panic disorder is described. Treatment modalities are summarized, and social, financial and medical consequences of nondetection are underlined.
Data Sources:
PSYCHLIT and MEDLINE searches under panic disorder and chest pain-related headings were conducted.
Data Extraction:
The search covered January 1973 to June 1993. Thirty-eight articles were studied.
Data Synthesis:
Panic disorder is present in 30% or more of chest pain patients with no or minimal CAD and may coexist with CAD. Panic disorder may often be unrecognized by physicians. Left untreated, risk for disease progression may be augmented, and social vocational disability as well as medical costs may increase.
Conclusion:
Physicians should attend to the panic symptomatology and, when in doubt, refer possible panic patients with or without CAD to a mental health professional for assessment and treatment. Future panic prevalence studies in cardiology patients should be prospective, attempt to increase sample size and use randomized protocols where experimenters are blind to chest pain and medical diagnoses. Studies should also focus on CAD patients with atypical chest pain refractory to optimal cardiac therapy.