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Panic disorder in coronary artery disease patients with noncardiac chest pain
R P Fleet1, G Dupuis, A Marchand
1Research Center, Montreal Heart Institute, Quebec, Canada.
Insights
Panic disorder (PD) is common in coronary artery disease (CAD) patients with chest pain. These patients experience significant psychological distress, linked to panic symptoms rather than cardiac issues.
Area of Science:
- Cardiology
- Psychiatry
- Emergency Medicine
Background:
- Chest pain is a common emergency department presentation.
- Coronary artery disease (CAD) and panic disorder (PD) can present with overlapping symptoms.
- Differentiating cardiac from psychiatric causes of chest pain is clinically important.
Purpose of the Study:
- To determine the prevalence of panic disorder (PD) in patients with coronary artery disease (CAD) presenting with chest pain.
- To compare psychological distress levels in patients with comorbid CAD and PD versus other patient groups.
Main Methods:
- A cohort of 441 emergency department patients with chest pain was assessed.
- Patients underwent structured psychiatric interviews (ADIS-R) and psychological scales.
- The study focused on the 250 patients diagnosed with noncardiac chest pain.
Main Results:
- Of patients with noncardiac chest pain, 30% had a history of CAD.
- Among CAD patients with noncardiac chest pain, 34% met criteria for PD.
- Patients with both CAD and PD reported significantly higher psychological distress than CAD patients without PD and those with neither condition.
Conclusions:
- Panic disorder is highly prevalent in CAD patients presenting with noncardiac chest pain.
- Psychological distress in these patients is primarily associated with panic syndrome.
- This highlights the need for integrated cardiac and psychiatric care in managing such patients.
Abstract:
In this study we address the following questions: (1) What percentage of coronary artery disease (CAD) patients that present with chest pain, but whose symptoms cannot be fully explained by their cardiac status, suffer from panic disorder (PD)? (2) How do patients with both CAD and PD compare to patients without CAD and to patients without either PD or CAD in terms of psychological distress? Four hundred forty-one consecutive walk-in emergency department patients with chest pain underwent a structured psychiatric interview (ADIS-R) and completed psychological scales. Fifty-seven percent (250 of 441) of these patients were diagnosed as having noncardiac chest pain and constituted this study's sample. A total of 30% (74 of 250) of noncardiac chest pain patients had a documented history of CAD. Thirty-four percent (25 of 74) of CAD patients met criteria for PD. Patients with both PD and CAD displayed significantly more psychological distress than CAD patients without PD and patients with neither CAD nor PD. However, they did not differ from non-CAD patients with PD. PD is highly prevalent in patients with CAD that are discharged with noncardiac diagnoses. The psychological distress in these patients appears to be related to the panic syndrome and not to the presence of the cardiac condition.