Objective: To examine the association among panic disorder, atypical chest pain and coronary artery disease (CAD). This article's purpose is to inform cardiologists of the prevalence of psychiatric disorders, primarily panic disorder, among patients consulting for chest pain. Panic disorder is described. Treatment modalities are summarized, and social, financial and medical consequences of nondetection are underlined.
Data sources: PSYCHLIT and MEDLINE searches under panic disorder and chest pain-related headings were conducted.
Data extraction: The search covered January 1973 to June 1993. Thirty-eight articles were studied.
Data synthesis: Panic disorder is present in 30% or more of chest pain patients with no or minimal CAD and may coexist with CAD. Panic disorder may often be unrecognized by physicians. Left untreated, risk for disease progression may be augmented, and social vocational disability as well as medical costs may increase.
Conclusion: Physicians should attend to the panic symptomatology and, when in doubt, refer possible panic patients with or without CAD to a mental health professional for assessment and treatment. Future panic prevalence studies in cardiology patients should be prospective, attempt to increase sample size and use randomized protocols where experimenters are blind to chest pain and medical diagnoses. Studies should also focus on CAD patients with atypical chest pain refractory to optimal cardiac therapy.