The panic attack is able to mimic the clinical presentation of an acute coronary syndrome (ACS), to the point of being clinically indistinguishable without appropriate investigations. However, the literature actually demonstrates that the 2 conditions are more related than just being differential diagnoses. Through a review of the literature involving epidemiological studies, randomised controlled trials, systematic reviews and meta-analyses found on a Medline search, the relation between panic disorder and ACS is explored in greater depth. Panic disorder, a psychiatric condition with recurrent panic attacks, has been found to be an independent risk factor for subsequent coronary events. This has prognostic bearing and higher mortality rates. Through activation of the sympathetic system by differing upstream mechanisms, the 2 conditions have similar presentations. Another psychiatric differential diagnosis would be that of akathisia, as an adverse effect to antidepressant medications. An overview on the investigations, diagnostic process, treatment modalities and prognoses of the two conditions is presented. Panic disorders remain under-diagnosed, but various interviews are shown to allow physicians without psychiatric training to accurately pick up the condition. Comprehensive multidisciplinary approaches are needed to help patients with both coronary heart disease and anxiety disorder.
Acute Coronary Syndrome ; diagnosis ; physiopathology ; psychology ; Humans ; Panic Disorder ; complications ; diagnosis ; physiopathology ; Risk Factors

OBJECTIVE: To determine the brain function and structure in patinets with first-episode panic disorder (PD). METHODS: All subjects (24 PD patients and 24 healthy subjects) received MRI scan and emotional counting Stroop task during the functional magnetic resonance imaging. Blood oxygenation level dependent functional magnetic resonance imaging and voxel-based morphometric technology were used to detect the gray matter volume. RESULTS: Compared with the healthy controls, left thalamus, left medial frontal gyrus, left anterior cingulate gyrus, left inferior frontal gyrus, left insula (panic-related words vs. neutral words) lacked activation in PD patients, but the over-activation were found in right brain stem, right occipital lobe/lingual gyrus in PD patients. Compared with the healthy controls, the gray matter volume in the PD patients significantly decreased in the left superior temporal gyrus, right medial frontal gyrus, left medial occipital gyrus, dorsomedial nucleus of left thalamus and right anterior cingulate gyrus. There was no significantly increased gray matter volume in any brain area in PD patients. CONCLUSION PD patients have selective attentional bias in processing threatening information due to the depression and weakening of the frontal cingulated gyrus.
Adolescent ; Adult ; Brain ; pathology ; physiopathology ; Case-Control Studies ; Female ; Frontal Lobe ; physiopathology ; Gyrus Cinguli ; physiopathology ; Humans ; Magnetic Resonance Imaging ; methods ; Male ; Panic Disorder ; pathology ; physiopathology ; Young Adult

Many studies showed abnormal serotonin transporter (5-HTT) function and heart rate variability (HRV) in panic disorder patients. The present study investigated the relationship between HRV power spectral analysis findings and platelet serotonin uptake in panic disorder patients. Short-term HRV over 5 min and platelet serotonin transporter uptake parameters (V(max) and K(m)) were measured both in 45 patients with panic disorder and in 30 age-matched normal healthy control subjects. Low frequency power (LF) normalized unit (nu) and LF/high frequency power (HF) were significantly higher, whereas HF and HF nu were lower in the patient group than in the control group. V(max) and K(m) were all significantly lower (i.e., reflects decreased 5-HTT function) in patients with panic disorder than in normal controls. In the patient group, Km was negatively correlated with LF/HF and LF nu whereas no such correlations between them were found in the control group. By multivariate analysis based on multiple hierarchical linear regression, a low Km independently predicted an increased LF nu even after controlling for age, sex, and body mass index in the patient group. These results suggest that impaired 5-HTT function is closely related to dysregulation of autonomic nervous system in panic disorder.
Adult ; Female ; Heart Rate/*physiology ; Humans ; Male ; Middle Aged ; Panic Disorder/*physiopathology ; Serotonin/metabolism ; Serotonin Plasma Membrane Transport Proteins/*metabolism ; Young Adult

OBJECTIVESTo explore the effects of Chinese medicine prescription Zuogui Pill (, ZGP) on monoamine neurotransmitters and sex hormones in climacteric rats with induced panic attacks.

METHODSForty-eight climacteric female rats were randomized into 6 groups with 8 rats in each group: the control group, the model group, the low-, medium- and high-dose ZGP groups and the alprazolam group. Rats in the low-, medium- and high-dose ZGP groups were administered 4.725, 9.45, or 18.9 g/kg ZGP by gastric perfusion, respectively. The alprazolam group was treated by gastric perfusion with 0.036 mg/kg alprazolam. The control and model groups were treated with distilled water. The animals were pretreated once daily for 8 consecutive weeks. The behaviors of rats in the open fifield test and the elevated T-maze (ETM) were observed after induced panic attack, and the levels of brain monoamine neurotransmitters and the plasma levels of sex hormones were measured.

RESULTSCompared with the control group, the mean ETM escape time and the levels of 5-hydroxytryptamine (5-HT) and noradrenalin (NE) of the model group were signifificantly reduced (P<0.05), Compared with the model group, the mean ETM escape time and the 5-HT and NE levels of all the ZGP groups increased signifificantly (P<0.05 or P<0.01). However, no signifificant difference was observed in the levels of sex hormones between the groups.

CONCLUSIONPretreatment with ZGP in climacteric rats may improve the behavior of panic attack, which may be related to increased 5-HT and NE in the brain.

Animals ; Behavior, Animal ; drug effects ; Biogenic Monoamines ; metabolism ; Climacteric ; drug effects ; Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Female ; Gonadal Steroid Hormones ; blood ; Maze Learning ; drug effects ; Neurotransmitter Agents ; metabolism ; Panic Disorder ; blood ; drug therapy ; physiopathology ; Rats ; Rats, Sprague-Dawley