Panic attacks and supraventricular tachycardias: the chicken or the egg?

Abstract

Panic attacks occur in about 2 % of the population. Symptoms include a racing or pounding heart beat, chest pain, dizziness, light-headedness, nausea, difficulty in breathing, tingling or numbness in the hands, flushes or chills, dreamlike sensations or perceptual distortions. The symptoms of paroxysmal supraventricular tachycardia (PSVT) may be similar. A PSVT is often difficult to document on the ECG since it has often ceased before the patient comes to medical attention. Besides, a tachycardia may still be present and even be documented but interpreted as a phenomenon secondary to the panic attack. In addition, ECG abnormalities between episodes can often not be identified. The evidence that in some patients paroxysmal SVT is the cause, but not the consequence of a panic attack, is based on observations that catheter ablation was able to cure patients presenting with panic disorders. To better establish the prevalence of SVT as the underlying mechanism of a panic attack, there is a need for prospective studies and/or registries. Whereas gastric ulcer has in some patients changed from a psychosomatic disorder to an infectious disease, we may hypothesise that a certain proportion of panic disorders may mutate into an underlying arrhythmia rather than a primary psychiatric disorder.

Neurocardiology: close interaction between heart and brain

“…Subarachnoid bleeding may lead to dramatic electrocardiographic changes and even ventricular fibrillation, possibly due to QT-interval prolongation [11,12]. Panic disorders and emotional distress such as the Takotsubo syndrome may give rise to (supra)ventricular tachycardias with ensuing transient left ventricular dysfunction [13][14][15][16]. Coronary artery bypass surgery (CABG) has major effects on neurocognitive functioning [17].…”

Supraventricular tachycardia and catheter ablation: Anxiety levels and patient perceptions

“…Moreover, female patients were more likely to attribute their palpitation to excitement, medication, or menopause, and this may be the reason why the mean anxiety level is similar between the genders as the palpitation was perceived to be a 'natural' event. Current literature states that males perceive cardiac disease more negatively and thus portray more anxiety and depressive symptoms 18. There was a significant association between anxiety during the index attack and patient age, as hypothesized (p = 0.028).…”

Is panic disorder a disorder of physical fitness? A heuristic proposal

“…PD patients who are normotensive exhibit an impaired circadian blood pressure pattern with an inadequate reduction in nighttime blood pressure (non-dipper pattern) 30 as well as an unstable heart rate while asleep 31 . At least in a certain proportion of patients with PD, PAs may be caused by paroxysmal supraventricular tachycardia 32 . In addition, these patients exhibit increased arterial stiffness, and several factors negatively affect endothelial function, such as increased homocysteine levels and platelet aggregation or volume and lower levels of nitric oxide 25 – 28 .…”