Heart Rate Variability and Cardiovascular Reactivity in Panic Disorder
Uniformed Services University Of The Health Sciences Bethesda United States
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Panic disorder, with a population prevalence of about 2-4, is a debilitating condition which, because of its overlapping symptomatology with cardiovascular disease, causes many patients to present initially to an emergency room or physicians office upon onset of a panic attack Beitman, Mukeiji, Aaker and Basha et al., 1988. Routine electrocardiographic assessment frequently fails to find a physical basis for symptoms such as chest pain or shortness of breath and physicians often do not recognize the presence of panic. Further complicating this situation is evidence suggesting that chest pain and microvascular angina, both of which can occur in patients with angiographically normal coronary arteries, may have a higher than expected prevalence in panic disorder patients. Despite being referred for psychological or psychiatric evaluation, many panic disorder patients continue to rely on emergency medical facilities when they have panic attacks. Although there is evidence that concerns about over-utilization of medical resources, coupled with the realization that panic disorder can present as impending myocardial infarction may discourage physicians from further follow-up of patients whose initial cardiac evaluation is negative awareness of the possible comorbidity of cardiovascular disease and panic disorder should encourage caution when dismissing a panic disorder patients cardiac symptoms Carter et al., 1994. Furthermore, recent studies suggest that panic disorder, overlooked or untreated, may lead not only to the development of cardiovascular disease but may exacerbate existing cardiovascular disease Katon, 1990.The possibility of an association between panic disorder and cardiovascular disease was proposed by Coryell, Noyes and Clancy 1982 and Coryell, Noyes and House 1986.