title: Myocardial perfusion study of panic attacks in patients with coronary artery disease.
abstract: Panic disorder (PD) and panic-like anxiety have been associated with an increased risk of cardiovascular death. No study has specifically examined the association between panic attacks and ischemia in patients who have coronary artery disease (CAD). We hypothesized that panic attacks would induce myocardial perfusion defects in patients who have CAD and PD. Sixty-five patients who had CAD and positive results with nuclear exercise stress testing (35 with PD and 30 without PD served as controls) underwent a well-established panic challenge test (1 vital capacity inhalation of a gas mixture containing 35% carbon dioxide and 65% oxygen) and were injected with technetium-99m sestamibi at inhalation. Single-photon emission computed tomography was used to assess per-panic challenge perfusion defects, and heart rate, blood pressure, and 12-lead electrocardiogram were continuously measured during the procedure. Patients were not withdrawn from their cardiac medications. Patients who had PD were significantly younger than the controls; otherwise groups did not differ with respect to gender, cardiac medications, nuclear exercise test results, and baseline heart rate and blood pressure. Seventy-four percent of patients (26 of 35) who had PD had a panic attack at inhalation versus 6.7% of controls (2 of 30, p <0.001). As hypothesized, patients who had PD and demonstrated a panic attack were more likely to develop a reversible myocardial perfusion defect than were controls who did not have an attack (80.9% vs 46.4% p = 0.009). Thus, despite being on their cardiac medications, panic attacks preferentially induced significant perfusion defects in patients who had CAD and PD. In conclusion, panic attacks in patients who have CAD appear to be bad for the heart.
authors.affiliation: Research Center, Montreal Heart Institute, Montreal, Quebec, Canada. rfleet@videotron.ca
authors.forename: Richard
authors.initials: R
authors.lastname: Fleet
authors.forename: François
authors.initials: F
authors.lastname: Lespérance
authors.forename: André
authors.initials: A
authors.lastname: Arsenault
authors.forename: Jean
authors.initials: J
authors.lastname: Grégoire
authors.forename: Kim
authors.initials: K
authors.lastname: Lavoie
authors.forename: Catherine
authors.initials: C
authors.lastname: Laurin
authors.forename: François
authors.initials: F
authors.lastname: Harel
authors.forename: Denis
authors.initials: D
authors.lastname: Burelle
authors.forename: Jean
authors.initials: J
authors.lastname: Lambert
authors.forename: Bernard
authors.initials: B
authors.lastname: Beitman
authors.forename: Nancy
authors.initials: N
authors.lastname: Frasure-Smith
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure; D002245:Carbon Dioxide / Q000008:administration & dosage; D003327:Coronary Disease / Q000150:complications* / Q000188:drug therapy; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000209:etiology*; D016584:Panic Disorder / Q000139:chemically induced / Q000150:complications*; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D002245:Carbon Dioxide