title: Panic attack triggering myocardial ischemia documented by myocardial perfusion imaging study. A case report.
abstract: BACKGROUND
  Chest 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.
  
  
  OBJECTIVE
  Faced 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.
  
  
  CONCLUSIONS
  Panic 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.
  
  
  CONCLUSIONS
  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, specifically at the interface of PD and cardiovascular disease.
authors.affiliation: Panic and Respiration Laboratory, Institute of Psychiatry, Federal University of Rio de Janeiro, INCT - Translational Medicine (CNPq), Rio de Janeiro, Brazil. galufo@gmail.com.
authors.forename: Gastão Luiz Fonseca
authors.initials: GL
authors.lastname: Soares-Filho
authors.forename: Claudio Tinoco
authors.initials: CT
authors.lastname: Mesquita
authors.forename: Evandro Tinoco
authors.initials: ET
authors.lastname: Mesquita
authors.forename: Oscar
authors.initials: O
authors.lastname: Arias-Carrión
authors.forename: Sergio
authors.initials: S
authors.lastname: Machado
authors.forename: Manuel Menéndez
authors.initials: MM
authors.lastname: González
authors.forename: Alexandre Martins
authors.initials: AM
authors.lastname: Valença
authors.forename: Antonio Egidio
authors.initials: AE
authors.lastname: Nardi