Panic disorder and the heart
Abstract
Panic disorder is a common condition that includes symptoms that may masquerade as a primary cardiovascular disorder. In addition, many patients with cardiovascular disease may also have panic disorder. To date, no definitive pathophysiological mechanism for panic disorder has been found; however, there are several hypotheses in the literature. Patients with syndrome X, coronary artery disease and/or palpitations, in addition to panic disorder all present to cardiologists. However, many patients go undiagnosed and ultimately place large costs on the health care system as a result. Panic disorder is a treatable condition, and cardiologists could easily identify patients with panic disorder and initiate appropriate therapy and/or referral.
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Psychosomatic disorders most frequently associated with palpitations include anxiety, panic attacks, depression, and somatization, which can either induce sinus tachycardia or modify the patient's subjective perception of a heartbeat that is otherwise normal or presents minimal irregularities.
“Psychosomatic disorders that are most frequently associated with palpitations include anxiety, panic attacks, depression, and somatization, which can either induce sinus tachycardia or modify the patient's subjective perception of a heartbeat that is otherwise normal or presents minimal irregularities.20 -23”
From Management of patients with palpitations: a position paper from the European Heart Rhythm Association (2011) · cites this paper as [23]
Cites
Autonomic balance revisited: Panic anxiety and heart rate variability
Friedman, B. H., & Thayer, J. F. (1998) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(97)00202-x · Cited by 616 · see citing works
Ballenger, J. C. (1988) · Archives of General Psychiatry · doi:10.1001/archpsyc.1988.01800290027004 · Cited by 564 · see citing works
Sartorius, N., Üstün, T. B., Lecrubier, Y., & Wittchen, H.-U. (1996) · British Journal of Psychiatry · doi:10.1192/s0007125000298395 · Cited by 541 · see citing works
Psychological treatment of panic: Work in progress on outcome, active ingredients, and follow-up
Margraf, J., Barlow, D. H., Clark, D. M., & Telch, M. J. (1993) · Behaviour Research and Therapy · doi:10.1016/0005-7967(93)90036-t · Cited by 377 · see citing works
Chouinard, G., Annable, L., Fontaine, R., & Solyom, L. (1982) · Psychopharmacology · doi:10.1007/bf00464571 · Cited by 256 · see citing works
Panic Disorder, Palpitations, and the Awareness of Cardiac Activity
BARSKY, A. J., CLEARY, P. D., SARNIE, M. K., & RUSKIN, J. N. (1994) · The Journal of Nervous and Mental Disease · doi:10.1097/00005053-199402000-00001 · Cited by 135 · see citing works
Schweizer, E. (1993) · Archives of General Psychiatry · doi:10.1001/archpsyc.1993.01820130053009 · Cited by 120 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Sense of humor and physical health: Theoretical issues, recent findings, and future directions
Martin, R. A. (2004) · Humor - International Journal of Humor Research · doi:10.1515/humr.2004.005 · Cited by 214 · see citing works
Grace, S., Abbey, S., Irvine, J., Shnek, Z., & Stewart, D. (2004) · Psychotherapy and Psychosomatics · doi:10.1159/000080387 · Cited by 199 · see citing works
Raviele, A., Giada, F., Bergfeldt, L., Blanc, J. J., Blomstrom-Lundqvist, C., Mont, L., Morgan, J. M., Raatikainen, M. J. P., Steinbeck, G., Viskin, S., et al. (2011) · Europace · doi:10.1093/europace/eur130 · Cited by 149 · see citing works
“When, after this history-taking, it becomes likely that palpitations are not related to arrhythmia but rather to psychosomatic disorders, before starting more extensive cardiovascular procedures, it is judicious to take the help of a mental health expert.(1,22,23,47,58)”
BackgroundKeogh, E., Hamid, R., Hamid, S., & Ellery, D. (2004) · Pain · doi:10.1016/j.pain.2004.06.017 · Cited by 112 · see citing works
“Keywords: Anxiety sensitivity; Gender differences; Pain; Cognitive biases; Cardiac Chest pain is a major symptom associated with coronary heart disease (CAD), angina pectoris, and myocardial infarction.”
BackgroundPanic & Plaques: Panic Disorder & Coronary Artery Disease in Patients with Chest Pain
Katerndahl, D. A. (2004) · The Journal of the American Board of Family Medicine · doi:10.3122/jabfm.17.2.114 · Cited by 40 · see citing works
Çiçek, Y., Durakoğlugil, M. E., Kocaman, S., Guveli, H., Çetin, M., Erdoǧan, T., Şahin, I., Doğan, S., & Çanga, A. (2012) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2012.05.012 · Cited by 34 · see citing works
“Panic disorder (PD), a subtype of anxiety disorder, poses difficulty in diagnosis due to considerable overlap in symptoms between PD and cardiac disorders [4].”
BackgroundIs there cardiac risk in panic disorder? An updated systematic review
Caldirola, D., Schruers, K. R. J., Nardi, A. E., Berardis, D. D., Fornaro, M., & Perna, G. (2016) · Journal of Affective Disorders · doi:10.1016/j.jad.2016.01.003 · Cited by 37 · see citing works
Srinivasan, K., & Joseph, W. (2004) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2004.06.001 · Cited by 29 · see citing works
“However, recognizing anxiety disorder, especially panic disorder among patients with myocardial infarction, is not easy due to commonality of symptoms [34], especially in developing countries where somatization of psychological distress is common [32].”
BackgroundDevelopment and initial validation of the Exercise Sensitivity Questionnaire
Farris, S. G., Burr, E. K., Kibbey, M. M., Abrantes, A., & DiBello, A. M. (2020) · Mental Health and Physical Activity · doi:10.1016/j.mhpa.2020.100346 · Cited by 26 · see citing works
Baker, B., Khaykin, Y., Devins, G. M., Dorian, P., Shapiro, C. M., & Newman, D. M. (2003) · The Canadian Journal of Psychiatry · doi:10.1177/070674370304800604 · Cited by 18 · see citing works
Self-citationClinical Approach to Patients with Palpitations
Giada, F., & Raviele, A. (2018) · Cardiac Electrophysiology Clinics · doi:10.1016/j.ccep.2018.02.010 · Cited by 21 · see citing works
Health care seeking behaviors, psychological factors, and quality of life of noncardiac chest pain.
Eslick, G. (2008) · Disease-a-month : DM · doi:10.1016/j.disamonth.2008.06.004 · Cited by 22
Autonomic Dysfunctions in Patients with Anxiety Throughout Therapy
Mussgay, L., & Rüddel, H. (2004) · Journal of Psychophysiology · doi:10.1027/0269-8803.18.1.27 · Cited by 18 · see citing works
“So far the cardiology perspective, however, has found no definite pathophysiological mechanism (Ehlers et al., 1988; Jeejeebhoy et al., 2000).”
BackgroundChest Pain and Its Importance in Patients With Panic Disorder: An Updated Literature Review
Katerndahl, D. A. (2008) · The Primary Care Companion to The Journal of Clinical Psychiatry · doi:10.4088/pcc.v10n0505 · Cited by 16 · see citing works
“In general, panic disorder should be suspected in patients with atypical chest pain, lack of organic causes of chest pain, asymptomatic MVP, and palpitations without significant arrhythmia.(94) Which patients presenting to emergency department and primary care physicians should be screened for panic disorder on the ba…”
BackgroundPupillary light reflex in panic disorder
Kojima, M., Shioiri, T., Hosoki, T., Kitamura, H., Bando, T., & Someya, T. (2004) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-004-0487-0 · Cited by 15
“…have focused on the sympathetic nervous system (SNS) in PD, especially the autonomic nervous system (ANS) that regulates the cardiovascular system (see reviews; Jeejeebhoy et al. 2000) since PD patients exhibit a high frequency of cardiovascular symptoms (Margraf et al. 1987; Shioiri et al. 1996).”
BackgroundPalpitations: Evaluation and management by primary care practitioners
Govender, I., Nashed, K. K., Rangiah, S., Okeke, S. O., & Maphasha, O. M. (2022) · South African Family Practice · doi:10.4102/safp.v64i1.5449 · Cited by 17 · see citing works
Psychological factors affecting cardiologic conditions.
Rafanelli, C., Roncuzzi, R., Ottolini, F., & Rigatelli, M. (2007) · Advances in Psychosomatic Medicine · doi:10.1159/000106798 · Cited by 13 · see citing works
Foldes‐Busque, G., Dionne, C. E., Turcotte, S., Tully, P. J., Tremblay, M.-A., Poirier, P., & Denis, I. (2021) · BMC Cardiovascular Disorders · doi:10.1186/s12872-021-01848-3 · Cited by 18 · see citing works
Shioiri, T., Kojima-Maruyama, M., Hosoki, T., Kitamura, H., Tanaka, A., Yoshizawa, M., Bando, T., & Someya, T. (2005) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-005-0561-2 · Cited by 11 · see citing works
“First, the sample size was relatively small, although three-fifths or greater than 50 previous studies had a similar sample size (see review; Friedman and Thayer 1998; Gorman and Solan 2000; Jeejeebhoy et al. 2000).”
MethodResultElectrocardiogram, vectocardiogram and body surface maps in patients with panic disorder.
Pišvejcová, K., Paclt, I., Slavíček, J., Kittnar, O., Dohnalová, A., & Kitzlerová, E. (2002) · Physiological Research · doi:10.33549/physiolres.930128 · Cited by 11
“No definitive pathophysiological mechanism for PD has yet been found (Jeejeebhoy et al. 2000).”
BackgroundShioiri, T., Kojima, M., Hosoki, T., Kitamura, H., Tanaka, A., Bando, T., & Someya, T. (2004) · Journal of Affective Disorders · doi:10.1016/j.jad.2004.03.008 · Cited by 10 · see citing works
“, 1994a, b), and there is an availability of invasive and easy clinical methods such as the power spectrum analysis for R–R intervals of ECG (see reviews; Jeejeebhoy et al., 2000).”
BackgroundMethodResultOcak, T., Erdem, A., Duran, A., Tekelioğlu, Ü. Y., Öztürk, S., Ayhan, S. S., Özlü, M. F., Tosun, M., Koçoğlu, H., & Yazıcı, M. (2013) · Clinics · doi:10.6061/clinics/2013(04)17 · Cited by 12 · see citing works
“Studies have shown that the prevalence of panic disorder in patients with palpitations is 15-31% (8,9).”
BackgroundAnxiety Sensitivity in Smokers with Indicators of Cardiovascular Disease
Farris, S. G., & Abrantes, A. (2017) · Psychology, Health & Medicine · doi:10.1080/13548506.2017.1300672 · Cited by 8 · see citing works
Ratcliffe, D., MacLeod, A. K., & Sensky, T. (2006) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465806002773 · Cited by 8 · see citing works
Tremblay, M.-A., Denis, I., Turcotte, S., Degrâce, M., Tully, P., & Foldes-Busque, G. (2022) · Journal of clinical psychology in medical settings · doi:10.1007/s10880-022-09876-7 · Cited by 6 · see citing works
Liu, X.-T., Xu, T.-T., Chen, D., Yang, C., Wang, P., Huang, X., Cheng, W.-H., Shen, Y., Liu, Q., & Wang, Z. (2020) · BMC Psychiatry · doi:10.1186/s12888-020-02560-w · Cited by 6 · see citing works
Investigation of anxiety levels of patients with chest pain admitted to emergency department
Basara, G., Baydın, A., Yilmaz, A., Yucel, O., Erenler, A., & Murat, N. (2015) · Turkish Journal of Emergency Medicine · doi:10.1016/j.tjem.2015.06.002 · Cited by 6
Shioiri, T., Kuwabara, H., Abe, R., Iijima, A., Kojima-Maruyama, M., Kitamura, H., Bando, T., & Someya, T. (2006) · Journal of Affective Disorders · doi:10.1016/j.jad.2006.04.031 · Cited by 6
“, 2000); although, many researchers have focused on it (see reviews; Jeejeebhoy et al., 2000).”
BackgroundPsychosocial interventions for panic disorder after coronary artery bypass graft: a case study.
Reid, T., Denieffe, S., Denny, M., & McKenna, J. (2005) · Dimensions of critical care nursing : DCCN · doi:10.1097/00003465-200507000-00004 · Cited by 6 · see citing works
Panic Disorder, Is It Really a Mental Disorder? From Body Functions to the Homeostatic Brain
Perna, G., Iannone, G., Torti, T., & Caldirola, D. (2016) · Springer eBooks · doi:10.1007/978-3-319-12538-1_4 · Cited by 4 · see citing works
Vicent, L., Rosillo, N., Moreno, G., Bodes, R. S., Goñi, C., Sobrino, J. L. B., Seara, G., & Bueno, H. (2023) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2023.1202960 · Cited by 5 · see citing works
Increased arterial stiffness parameters in panic disorder patients in long term treatment period
Yanartaş, O., Sunbul, M., Şenkal, Z., Durmuş, E., Kıvrak, T., Subasi, N., Karaer, G., Ergun, S., Sari, I., & Sayar, K. (2016) · Annals of General Psychiatry · doi:10.1186/s12991-016-0102-6 · Cited by 4 · see citing works
“In three studies both decreasing symptom severity and using of antidepressant medication have been found to be related to arterial stiffness [8, 13, 14].”
BackgroundEsan, O., & Baiyewu, O. (2013) · Psychosomatics · doi:10.1016/j.psym.2013.02.010 · Cited by 3 · see citing works
Kisely, S. R., Campbell, L. A., Yelland, M. J., & Paydar, A. (2015) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004101.pub5 · Cited by 160 · see citing works
Psychosomatische Aspekte der Dyspnoe
Köllner, V. (2012) · Der Pneumologe · doi:10.1007/s10405-011-0568-5 · Cited by 2 · see citing works
La gestione del paziente con palpitazioni
Giada, F., Inama, G., Bertaglia, M., Pedrinazzi, C., Gulizia, M. M., Ricci, R. P., & Raviele, A. (2010) · Giornale italiano di cardiologia · doi:10.1714/568.6749 · Cited by 2 · see citing works
Approaches to panic attack symptoms in cardiology outpatients
Örüm, D., Abuş, S., & Kapıcı, Y. (2025) · Scientific Reports · doi:10.1038/s41598-025-93701-2 · Cited by 1 · see citing works
“Only three variables (routine echocardiogram examination, routine cardiology consultation by a non-cardiologist, and approach in the presence of non-cardiac PA symptoms in addition to CVD) were included given their contribution to the model.”
InfluentialIl cardiopalmo: epidemiologia, classificazione e prognosi
Pedrinazzi, C., Durin, O., Bonara, D., Inama, L., & Inama, G. (2010) · Giornale italiano di cardiologia · doi:10.1714/660.7679
Angststörungen und funktionelle somatische Syndrome in der Kardiologie
Köllner, V., Berg, G., & Kindermann, I. (2007) · doi:10.1055/s-2007-993093
Panic symptoms at the interface of body and mind
Colón, E. (2006) · Current Psychiatry Reports · doi:10.1007/s11920-006-0027-x
Wolfersdorf, M., Mauerer, C., Heindl, A., & Schiller, M. (2001) · doi:10.1055/s-2001-15332
- Authors
- Jeejeebhoy, F. M., Dorian, P., & Newman, D. M.
- Affiliations
- St. Michael's Hospital (CA)
- Corresponding author
- Newman, David M
- Venue
- Journal of Psychosomatic Research
- Publisher
- Elsevier BV
- Published
- 2000-04
- Volume
- 48
- Issue
- 4-5
- Pages
- 393-403
- ISSN
- 0022-3999 (ISSN-L)
- OpenAlex
- W205885688
- Cited by
- 46
- References
- 0
- Citations by year
- 2025: 1 · 2023: 1 · 2022: 2 · 2021: 1 · 2020: 2 · 2018: 1 · 2017: 1 · 2016: 3 · 2015: 2 · 2013: 2 · 2012: 4
- FWCI
- 0.26
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Psychosomatic Research (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Keywords
- panic disorder, cardiovascular disease, cardiac symptoms, misdiagnosis, metabolic syndrome, coronary artery disease, palpitations, pathophysiology, health care costs, cardiologist referral
- MeSH terms
- Cardiovascular Diseases, Diagnosis, Differential, Humans, Referral and Consultation, Panic Disorder
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