title: Cardiac sarcoidosis resembling panic disorder: a case report.
abstract: Sarcoidosis is a systemic disease of unknown etiology, in which granulomas develop in various organs, including the skin, lungs, eyes, or heart. It has been reported that patients with sarcoidosis are more likely to develop panic disorder than members of the general population. However, there are many unknown factors concerning the causal relationship between these conditions.
  
  
  
  We present the case of a 57-year-old woman who appeared to have panic disorder, as she experienced repeated panic attacks induced by transient complete atrioventricular block, associated with cardiac sarcoidosis. Psychotherapy and pharmacotherapy were not effective in the treatment of her panic attacks. However, when we implanted a permanent pacemaker and initiated steroid treatment for cardiac sarcoidosis, panic attacks were ameliorated. Based on these findings, we diagnosed the patient's symptoms as an anxiety disorder associated with cardiac sarcoidosis, rather than panic disorder.
  
  
  
  This report highlights the importance of considering cardiac sarcoidosis in the differential diagnosis of panic disorder. This cardiac disease should be considered especially in patients have a history of cardiac disease (e.g., arrhythmia) and atypical presentations of panic symptoms. Panic disorder is a psychiatric condition that is typically diagnosed after other medical conditions have been excluded. Because the diagnosis of sarcoidosis is difficult in some patients, caution is required. The palpitations and symptoms of heart failure associated with cardiac sarcoidosis can be misdiagnosed as psychiatric symptoms of panic disorder. The condition described in the current case study appears to constitute a physical disease, the diagnosis of which requires significant consideration and caution.
authors.affiliation: Department of Neuropsychiatry, Towada City Hospital, Towada, 034-0093, Japan. keitakeita77@hotmail.com.
authors.forename: Keita
authors.identifier: 0000-0001-6747-4348
authors.initials: K
authors.lastname: Tokumitsu
authors.affiliation: Department of Cardiology, Towada City Hospital, Towada, 034-0093, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Demachi
authors.affiliation: Department of Cardiology, Towada City Hospital, Towada, 034-0093, Japan.
authors.forename: Yukichi
authors.initials: Y
authors.lastname: Yamanoi
authors.affiliation: Department of Cardiology, Towada City Hospital, Towada, 034-0093, Japan.
authors.forename: Shigeto
authors.initials: S
authors.lastname: Oyama
authors.affiliation: Department of Neuropsychiatry, Towada City Hospital, Towada, 034-0093, Japan.
authors.forename: Junko
authors.initials: J
authors.lastname: Takeuchi
authors.affiliation: Department of Neuropsychiatry, Towada City Hospital, Towada, 034-0093, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Yachimori
authors.affiliation: Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki, 036-8562, Japan.
authors.forename: Norio
authors.initials: N
authors.lastname: Yasui-Furukori
mesh_terms: D009202:Cardiomyopathies / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology*; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D004562:Electrocardiography / Q000523:psychology; D005260:Female; D006801:Humans; D008875:Middle Aged; D016584:Panic Disorder / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology*; D012507:Sarcoidosis / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology*
keywords: Anxiety disorder; Cardiac sarcoidosis; Panic attacks; Panic disorder