Hypocapnia associated with cardiac stress scintigraphy in chest pain patients with panic disorder

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Abstract

Objective: Patients with recurrent chest pain but no evidence of coronary artery disease often meet diagnostic criteria for panic disorder (PD). However, it can be argued that the phenomenological diagnosis of PD may not be valid in these normal coronary chest pain (NCCP) patients. The purpose of this study is to additionally validate the diagnosis of PD in chest pain patients by comparing PCO2 levels before and during myocardial stress scintigraphy in those with and without PD. Method: End-tidal PCO2 was measured before and during myocardial stress scintigraphy in 22 patients being evaluated for chest pain. Psychiatric diagnoses were assessed by structured interview. Results: Eleven of the 19 patients (58%) with negative scintigrams met DSM-III-R diagnostic criteria for current panic disorder. Prestress PCO2 levels were significantly lower in these patients. Eight of the nine NCCP patients with prestress PCO2 < 34 mm Hg had PD. Conclusions: The finding of stress-related hypocapnia associated with PD in NCCP patients provides additional support for the validity of the diagnosis of PD in this population. The potential value of PCO2 measurements in screening for PD in patients with chest pain merits additional study.

Original languageEnglish (US)
Pages (from-to)52-55
Number of pages4
JournalPsychosomatic Medicine
Volume60
Issue number1
StatePublished - Jan 1998

Fingerprint

Hypocapnia
Panic Disorder
Chest Pain
Radionuclide Imaging
Myocardial Perfusion Imaging
Mental Disorders
Diagnostic and Statistical Manual of Mental Disorders
Coronary Artery Disease
Interviews

Keywords

  • Hyperventilation
  • Noncardiac chest pain
  • Normal coronary arteries

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Psychology(all)

Cite this

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title = "Hypocapnia associated with cardiac stress scintigraphy in chest pain patients with panic disorder",
abstract = "Objective: Patients with recurrent chest pain but no evidence of coronary artery disease often meet diagnostic criteria for panic disorder (PD). However, it can be argued that the phenomenological diagnosis of PD may not be valid in these normal coronary chest pain (NCCP) patients. The purpose of this study is to additionally validate the diagnosis of PD in chest pain patients by comparing PCO2 levels before and during myocardial stress scintigraphy in those with and without PD. Method: End-tidal PCO2 was measured before and during myocardial stress scintigraphy in 22 patients being evaluated for chest pain. Psychiatric diagnoses were assessed by structured interview. Results: Eleven of the 19 patients (58{\%}) with negative scintigrams met DSM-III-R diagnostic criteria for current panic disorder. Prestress PCO2 levels were significantly lower in these patients. Eight of the nine NCCP patients with prestress PCO2 < 34 mm Hg had PD. Conclusions: The finding of stress-related hypocapnia associated with PD in NCCP patients provides additional support for the validity of the diagnosis of PD in this population. The potential value of PCO2 measurements in screening for PD in patients with chest pain merits additional study.",
keywords = "Hyperventilation, Noncardiac chest pain, Normal coronary arteries",
author = "Maddock, {Richard J} and Carter, {Cameron S} and Lisa Tavano-Hall and Amsterdam, {Ezra A}",
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T1 - Hypocapnia associated with cardiac stress scintigraphy in chest pain patients with panic disorder

AU - Maddock, Richard J

AU - Carter, Cameron S

AU - Tavano-Hall, Lisa

AU - Amsterdam, Ezra A

PY - 1998/1

Y1 - 1998/1

N2 - Objective: Patients with recurrent chest pain but no evidence of coronary artery disease often meet diagnostic criteria for panic disorder (PD). However, it can be argued that the phenomenological diagnosis of PD may not be valid in these normal coronary chest pain (NCCP) patients. The purpose of this study is to additionally validate the diagnosis of PD in chest pain patients by comparing PCO2 levels before and during myocardial stress scintigraphy in those with and without PD. Method: End-tidal PCO2 was measured before and during myocardial stress scintigraphy in 22 patients being evaluated for chest pain. Psychiatric diagnoses were assessed by structured interview. Results: Eleven of the 19 patients (58%) with negative scintigrams met DSM-III-R diagnostic criteria for current panic disorder. Prestress PCO2 levels were significantly lower in these patients. Eight of the nine NCCP patients with prestress PCO2 < 34 mm Hg had PD. Conclusions: The finding of stress-related hypocapnia associated with PD in NCCP patients provides additional support for the validity of the diagnosis of PD in this population. The potential value of PCO2 measurements in screening for PD in patients with chest pain merits additional study.

AB - Objective: Patients with recurrent chest pain but no evidence of coronary artery disease often meet diagnostic criteria for panic disorder (PD). However, it can be argued that the phenomenological diagnosis of PD may not be valid in these normal coronary chest pain (NCCP) patients. The purpose of this study is to additionally validate the diagnosis of PD in chest pain patients by comparing PCO2 levels before and during myocardial stress scintigraphy in those with and without PD. Method: End-tidal PCO2 was measured before and during myocardial stress scintigraphy in 22 patients being evaluated for chest pain. Psychiatric diagnoses were assessed by structured interview. Results: Eleven of the 19 patients (58%) with negative scintigrams met DSM-III-R diagnostic criteria for current panic disorder. Prestress PCO2 levels were significantly lower in these patients. Eight of the nine NCCP patients with prestress PCO2 < 34 mm Hg had PD. Conclusions: The finding of stress-related hypocapnia associated with PD in NCCP patients provides additional support for the validity of the diagnosis of PD in this population. The potential value of PCO2 measurements in screening for PD in patients with chest pain merits additional study.

KW - Hyperventilation

KW - Noncardiac chest pain

KW - Normal coronary arteries

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