Am J Psychiatry 1993; 150:780-785
Copyright © 1993 by American Psychiatric Association
Panic disorder in cardiac outpatients
JM Chignon, JP Lepine and J Ades
Department of Psychiatry, Hopital Louis Mourier, Colombes, France.
OBJECTIVE: Continuing the long history of interest in the relation of
anxiety disorders to cardiovascular function and symptoms, this study
investigated the level of anxiety and prevalence of panic disorder in
cardiac patients and the possible associations between specific abnormal
ECG results and a diagnosis of panic disorder. METHOD: Consecutive patients
referred for ambulatory ECG recordings were assessed with the seven anxiety
items of the Hospital Anxiety and Depression Scale. Then, 50 patients with
scores higher than 8 (the anxious group) were interviewed with the Schedule
for Affective Disorders and Schizophrenia--Lifetime Version Modified for
the Study of Anxiety Disorders (SADS-LA). RESULTS: Of the 50 anxious
patients (26 male and 24 female) interviewed with the SADS-LA, 62% (N = 31)
met the DSM-III-R criteria for panic disorder. Patients with panic disorder
had a higher mean maximal heart rate and a shorter P-R interval than
patients without panic disorder. Unlike the patients without panic
disorder, the patients with panic disorder showed no correlation between
maximal heart rate and minimal P-R interval. CONCLUSIONS: The rate of panic
disorder was high in the patients referred for ECG. Moreover, the
prevalence of panic disorder was similar in the patients with and without
ECG abnormalities, indicating that in anxious patients the presence of
panic disorder does not rule out organic cardiac disease. On the other
hand, the higher maximal heart rate and shorter P- R interval of the panic
patients may be attributable to hypersensitivity of beta-adrenergic
receptors in panic disorder.
