Investigation of Panic Attack Patients Presenting to the Emergency Department of Bezmialem Vakıf University with Chest Pain

Introduction Panic attacks are severe attacks of fear and anxiety that occur at certain times. It starts suddenly and quickly reaches the top. It can take from 1-2 minutes to several hours. Chest pain is a common symptom of panic attacks. Especially the presence of chest pain causes repetitive emergency deparment admissions. In this study, we evaluated the patients who presented to the emergency department with chest pain and panic attack symptoms. We aimed to prevent the inappropriate treatment given to these patients by investigating the panic attack patients for whom the diagnosis of Acute Coronary Syndrome was ruled out. Method This study was carried out retrospectively. 32 patients with chest pain among 136 patients diagnosed with panic attack in the Emergency Department. The demographic information, complaints, chronic diseases of the patients and the results of the blood tests were recorded. Results Patients with a diagnosis of panic attack frequently apply to emergency services. Among the patients, women were in the majority and the average age of all patients was 41 years. More than half of the patients had tomography, ultrasound, echocardiography and magnetic resonance imaging. The analysis and imaging results requested from the patients were normal. Most of the patients who present to the emergency department with chest pain complaints are discharged after excluding life-threatening conditions, saying that there is no acute condition. In fact, the main reason for this is the inadequate communication with the patient. However, the underlying condition in patients is likely to be panic attacks. It is important to evaluate non-cardiac chest pain in emergency departments. In this way, unnecessary analysis is not done, time management is healthier and most importantly, patients do not use unnecessary medication.

Keywords:

Panic attack Chest pain, Emergency department,

PDF

___

1. Chalmers, J. A., Quintana, D. S., Abbott, M. J., & Kemp, A. H. Anxiety Disorders Are Associated With Reduced Heart Rate Variability: A Meta-Analysis. Frontiers in Psychiatry. 2014;11;5:80
2. Perna G, Caldirola D. Management of Treatment-Resistant Panic Disorder. Curr Treat Options Psychiatry. 2017;4(4):371-386
3. Huffman JC, Pollack MH, Theodore A. Panic Disorder and Chest Pain: Mechanisms, Morbidity, and Management. Prim Care Companion J Clin Psychiatry. 2002; 4(2): 54–62.
4. Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F, et al. . 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: the task force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016;37:267–315
5. Zane RD, McAfee AT, Sherburne S, Billeter G, Barsky A. Panic Disorder and Emergency Services. Acad Emerg Med. 2003;10(10):1065-1069.
6. Asmundson GJ, Taylor S. Panic disorder and agoraphobia: an overview and commentary on DSM-5 changes Depress. Anxiety, 2014;31:480-486
7. Greenslade JH, Hawkins T, Parsonage W, Cullen L. Panic Di- order in Patients Presenting to the Emergency Department With Chest Pain: Prevalence and Presenting Symptoms. He- art Lung Circ. 2017;26(12):1310-1316.
8. Caldirola, D. Schruers KR. Nardi A. Is There Cardiac Risk in Panic Disorder? An Updated Systematic Review. Journal of Affect Disorders. 2016;194:38–49.
9. Machado, S. Sancassiani, F. Paes, F, Rocha, N., Murillo-Rodrigu- ez, E. Panic Disorder, and Cardiovascular Diseases: An Overview. International Review of Psychiatry. 2017;29(5):436–444
10. Soh KC, Lee C. Panic attack and its correlation with the acute coronary syndrome - more than just a diagnosis of exclusion. Ann Acad Med Singapore. 2010;39(3):197–202
11. Gensichen J, Hiller TS, Breitbart J, Brettschneider C, Teismann T, Schumacher U, Lukaschek K, Schelle M. Panic Disorder in Primary Care. Dtsch Arztebl Int. 2019;8;116(10):159-166
12. Siegmann E, Müller H, Luecke C, Philipsen A, Kornhuber J, Grömer T. Association of Depression and Anxiety Disorders With Autoimmune Thyroiditis: A Systematic Review and Me- ta-analysis. JAMA Psychiatry. 2018;75(6):577-584