Abstract
BackgroundChest 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.ObjectiveFaced 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.DiscussionPanic 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.ConclusionThe 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.
Highlights
Chest pain, a key element in the investigation of coronary artery disease is often regarded as a benign prognosis when present in panic attacks
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, at the interface of Panic disorder (PD) and cardiovascular disease
Summary
A key element in the investigation of coronary artery disease is often regarded as a benign prognosis when present in panic attacks. The challenge is to diagnose acute coronary syndromes (ACS) in patients who present with the traditional combination of anginal chest pain and electrocardiography (ECG) changes but to recognize the presence of myocardial ischemia in situations of low probability. -called “respiratory symptoms” [3] of a PA are seen in heart disease These include choking/smothering sensations, shortness of breath, palpitation or accelerated heart rate, and CP. Patients presenting a PA very often seek emergency assistance They are examined with a chest pain unit protocol [5] and released with the sole diagnosis that they are not presenting an ACS, without an investigation regarding possible psychiatric disorders. More than half of CP patients without ACS present an undiagnosed anxiety disorder [6], some studies have questioned the benign prognosis of PD
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