Abstract
Background
Patients presenting with chest pain may or may not be experiencing a panic attack. Is chest pain caused by a panic attack or myocardial infarction with non-obstructive coronary arteries (MINOCA) syndrome?
Aim
In this study, we evaluated both MINOCA syndrome and HEART score in patients who presented to the emergency department with panic attacks and chest pain.
Method
Patients who applied to the emergency department with panic disorder and chest pain complaints were included. Patients who met the MINOCA diagnostic criteria were identified. The study was completed with 143 eligible patients out of a total of 217 patients evaluated. The patients were divided into two groups. The first group was those whose symptoms and test results were consistent with MINOCA. The second group was composed of those whose chest pain was considered non-specific. The HEART score of all patients was calculated. The demographic characteristics, symptoms, and HEART scores were compared between the groups.
Results
Of the 143 patients evaluated in the study, 62 (43.3%) were male and 81 (56.7%) were female. While the mean HEART score was 4.7 ± 1.5 in the MINOCA group, it was 2.0 ± 1.0 in the non-cardiac group, a statistically significant difference.
Conclusion
Clinicians should pay attention to the patient’s age, gender, number of attacks per week, HEART score, and which symptoms (palpitations, shortness of breath, and fear of death) are present in patients who meet the panic attack diagnostic criteria. Clinicians should be alert to the MINOCA syndrome in panic attack patients.
Similar content being viewed by others
References
Chalmers JA, Quintana DS, Abbott MJ et al (2014) Anxiety disorders are associated with reduced heart rate variability: a meta-analysis. Front Psychiatry 5:80. https://doi.org/10.3389/fpsyt.2014.00080
Koefoed P, Woldbye DP, Hansen TO et al (2010) Gene variations in the cholecystokinin system in patients with panic disorder. Psychiatr Genet 20(2):59–64. https://doi.org/10.1097/YPG.0b013e32833511a8
Asmundson GJ, Taylor S, Smits JA (2014) Panic disorder and agoraphobia: an overview and commentary on DSM-5 changes. Depress Anxiety 31(6):480–486. https://doi.org/10.1002/da.22277
Perna G, Caldirola D (2017) Management of treatment-resistant panic disorder. Curr Treat Options Psychiatry 4(4):371–386. https://doi.org/10.1007/s40501-017-0128-7
Huffman JC, Pollack MH, Theodore A (2002) Panic disorder and chest pain: mechanisms, morbidity, and management. Prim Care Companion J Clin Psychiatry 4(2):54–62. https://doi.org/10.4088/pcc.v04n0203
Benamer H, Bouaouina MS, Masri A et al (2019) Vasospastic angina: an under-diagnosed pathology. Ann Cardiol Angeiol (Paris) 68(5):341–346. https://doi.org/10.1016/j.ancard.2019.08.006
Pasupathy S, Air T, Dreyer RP et al (2015) Systematic review of patients presenting with suspected myocardial infarction and nonobstructive coronary arteries. Circulation 131(10):861–870. https://doi.org/10.1161/CIRCULATIONAHA.114.011201
Agewall S, Beltrame JF, Reynolds HR et al (2017) ESC working group position paper on myocardial infarction with non-obstructive coronary arteries. Eur Heart J 38(3):143–153. https://doi.org/10.1093/eurheartj/ehw149
Matta A, Bouisset F, Lhermusier T et al (2020) Coronary artery spasm: new ınsights. J Interv Cardiol 14(2020):5894586. https://doi.org/10.1155/2020/5894586
Backus BE, Six AJ, Kelder JC et al (2013) A prospective validation of the HEART score for chest pain patients at the emergency department. Int J Cardiol 168(3):2153–2158. https://doi.org/10.1016/j.ijcard.2013.01.255
Gulati M, Levy PD, Mukherjee D et al (2021) 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the evaluation and diagnosis of chest pain: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 144(22):368–454. https://doi.org/10.1161/CIR.0000000000001029
Smilowitz NR, Mahajan AM, Roe MT et al (2017) Mortality of myocardial infarction by sex, age, and obstructive coronary artery disease status in the ACTION Registry-GWTG (Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines). Circ Cardiovasc Qual Outcomes 10(12):003443. https://doi.org/10.1161/CIRCOUTCOMES.116.003443
Safdar B, Spatz ES, Dreyer RP et al (2018) Presentation, clinical profile, and prognosis of young patients with myocardial infarction with nonobstructive coronary arteries (MINOCA): results from the VIRGO study. J Am Heart Assoc 7:009174. https://doi.org/10.1161/JAHA.118.009174
Olaya B, Moneta MV, Miret M et al (2018) Epidemiology of panic attacks, panic disorder and the moderating role of age: Results from a population-based study. J Affect Disord 7(13):009174. https://doi.org/10.1016/j.jad.2018.08.069
Kosmas N, Manolis AS, Dagres N et al (2020) Myocardial infarction or acute coronary syndrome with non-obstructive coronary arteries and sudden cardiac death: a missing connection. Europace 22(9):1303–1310. https://doi.org/10.1093/europace/euaa156
Sandau KE, Funk M, Auerbach A et al (2017) Update to practice standards for electrocardiographic monitoring in hospital settings: a scientific statement from the American Heart Association. Circulation 136(19):273–344. https://doi.org/10.1161/CIR.0000000000000527
Locke AB, Kirst N, Shultz CG (2015) Diagnosis and management of generalized anxiety disorder and panic disorder in adults. Am Fam Physician 91(9):617–624
Allabadi H, Alkaiyat A, Alkhayyat A et al (2019) Depression and anxiety symptoms in cardiac patients: a cross-sectional hospital-based study in a Palestinian population. BMC Public Health 19(1):232
Meuret A, Kroll J, Ritz T (2017) Panic disorder comorbidity with medical conditions and treatment implications. Annu Rev Clin Psychol 13(1):209–240
Author information
Authors and Affiliations
Contributions
All authors contributed equally to all stages of the research.
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing interests.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Taslidere, B., Atsiz, A. Evaluation of MINOCA syndrome and HEART score in patients presenting to the emergency department with panic attack and chest pain complaints. Ir J Med Sci 191, 2351–2356 (2022). https://doi.org/10.1007/s11845-022-03018-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11845-022-03018-6