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Cited by 35Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesCardiac Health and Mental HealthPsychosomatic Disorders and Their Treatments

Panic Disorder and Chest Pain: Mechanisms, Morbidity, and Management

Open access
Huffman, Jeff C., Pollack, Mark H., Stern, Theodore A.·2002·The Primary Care Companion For CNS Disorders
DOI 10.4088/pcc.v04n0203PMC PMC181226
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Abstract

Approximately one quarter of patients who present to physicians for treatment of chest pain have panic disorder. Panic disorder frequently goes unrecognized and untreated among patients with chest pain, leading to frequent return visits and substantial morbidity. Panic attacks may lead to chest pain through a variety of mechanisms, both cardiac and noncardiac in nature, and multiple processes may cause chest pain in the same patient. Panic disorder is associated with elevated rates of cardiovascular diseases, including hypertension, cardiomyopathy, and, possibly, sudden cardiac death. Furthermore, patients with panic disorder and chest pain have high rates of functional disability and medical service utilization. Fortunately, panic disorder is treatable; selective serotonin reuptake inhibitors, benzodiazepines, and cognitive-behavioral psychotherapy all effectively reduce symptoms. Preliminary studies have also found that treatment of patients who have panic disorder and chest pain with benzodiazepines results in reduction of chest pain as well as relief of anxiety.

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Crossref · 10.4088/pcc.v04n0203

Cites

116 of 116 references verified0 citation errors · 0 not checkable

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  • Chest pain is a common functional symptom caused by hyperventilation-related constriction of the coronary arteries.

    “Chest pain is a common functional symptom caused by hyperventilation-related constriction of the coronary arteries [98,99,100].”

    From Illness-Promoting Psychological Processes in Children and Adolescents with Functional Neurological Disorder (2023) · cites this paper as [100]

    The Cardiac Mechanisms section says hyperventilation during panic attacks can cause coronary artery spasm, leading to ischemia and chest pain. But it describes this as cardiac chest pain, not a functional symptom, and presents it as one of several possible mechanisms rather than the general cause of chest pain. (LLM, conf=0.86)

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  • Hyperventilation results in hypocapnia-low arterial carbon dioxide and respiratory alkalosis-that is responsible for a broad range of functional somatic symptoms, including hyperventilation-related chest pain.

    “It results in hypocapnia—low levels of arterial carbon dioxide and a respiratory alkalosis—that is responsible for a broad range of functional somatic symptoms, including hyperventilation-related chest pain.”

    From Illness-Promoting Psychological Processes in Children and Adolescents with Functional Neurological Disorder (2023) · cites this paper as [100]

    The Cardiac Mechanisms section says hyperventilation via alkalosis can lead to coronary spasm and chest pain; Noncardiac Mechanisms (p. 55) also links hyperventilation to possible musculoskeletal chest pain. The copy does not state that hyperventilation causes hypocapnia or that hypocapnia and respiratory alkalosis are responsible for a broad range of functional somatic symptoms. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

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Cites

Flagged first, then by citations

1 of the 117 references couldn’t be matched to a known paper.

Research works printed but not linked: 3

  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC: American Psychiatric Press; 1994:397-403
  2. Van Ravenswaaij-Arts CA, Kollee LA, Hopman JW, et al. Heart rate vari- ability. Ann Intern Med 1993;119:436-447
  3. Simpson RJ, Kazmierczak T, Power KG, et al. Controlled comparison of patients with panic disorder. Br J Gen Pract 1994;44:352-356

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Authors
Huffman, J. C., Pollack, M. H., & Stern, T. A.
Affiliations
Harvard University (US)
ORCID
Venue
The Primary Care Companion For CNS Disorders
Publisher
Physicians Postgraduate Press, Inc
Published
2002-04-01
Volume
4
Issue
2
Pages
54-62
ISSN
  • 2155-7772 (ISSN-L)
  • 2155-7780
DOI
10.4088/pcc.v04n0203
PMC
PMC181226
OpenAlex
W2054257116
Cited by
35
References
117
Citations by year
2026: 2 · 2025: 1 · 2024: 2 · 2023: 2 · 2022: 3 · 2021: 1 · 2020: 2 · 2019: 1 · 2017: 1 · 2016: 3 · 2015: 3 · 2014: 2 · 2013: 4 · 2012: 1
FWCI
0.96
Type
journal article
Language
en
Open access
Locations
  • The Primary Care Companion For CNS Disorders (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
  • Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
Keywords
panic disorder, chest pain, panic attacks, cardiovascular comorbidity, hypertension, cardiomyopathy, sudden cardiac death, functional disability, health care utilization, selective serotonin reuptake inhibitors, benzodiazepines, cognitive behavioral therapy, anxiety, underdiagnosis

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