Getting to the heart of panic disorder.

Getting to the heart of panic disorder 

Some people walking into an emergency room or doctor's office with a pounding heart or chest pain may be suffering from a panic attack, a syndrome that can mimic symptoms of a heart attack, says Wayne Katon of the University of Washington Medical School in Seattle. Often, physicians send these patients on for expensive cardiac tests, leaving the panic disorder undiagnosed and untreated, Katon reported at the 16th American Heart Association Science Writers Forum in Monterey, Calif.

To test the theory that primary-care doctors frequently don't distinguish between heart attacks and panic attacks, Katon studied 74 people with chest pain who were sent on for coronary arteriography, a $2,000 procedure that determines whether blood vessels are clogged with plaque. Nearly 38 percent of these patients showed no evidence of coronary disease. Psychiatric evaluations of the chest-pain patients with healthy hearts revealed that 43 percent met the standard diagnostic criteria for panic disorder, compared with nearly 7 percent of the patients whose tests confirmed heart disease.

The results suggest physicians need to be educated to consider the possibility of panic disorder when patients complain of chest pain. People having heart attacks report a certainly located pain that radiates to the nech and arms, Katon says. In contrast, panic-attack patients may report a pain on the right side of the chest. The typical panic-attack victim is a woman in her 20s or 30s, he says, while the typical heart-attack patient is a middle-aged man. There are many exceptions, however, and Katon says he is not recommending that physicians automatically exempt such patients from cardiac testing. All patients with chest pain should see a physician, he adds.

Physicians have reported panic disorder at least since the 1800s. The attacks can be triggered by a stressful event such as combat duty or divorce. But many patients can't identify any specific cause of their distress. Katon says it's likely a series of small stresses may cause panic attacks in these people.

Panic disorder can be functionally crippling, especially when undiagnosed. In the throes of a panic attack, many patients believe they are in imminent danger of a heart attack, even when doctors tell them they don't have evidence of blocked arteries. some restrict their activities to avoid their symptons; some give up their jobs due to the condition. But Katon says that in many cases, once the panic disorder is diagnosed, attacks can be prevented with antidepresants.