Panic attacks’ bizarre effects on the heart, or vice versa

A team of UK researchers have found that although people under 50 diagnosed with panic disorder (PD) suffer a higher risk of myocardial infarction (MI) and subsequent coronary heart disease (CHD) than the general population, their risk of ultimately dying from CHD is actually lower.
The researchers looked at 400,000 primary-care patients across the age spectrum, nearly 58,000 with PD and about 347,000 without. They found that people with panic disorder under 50 were 38% more likely to have experienced an MI and 44% more likely to have developed CHF. However, when looking at all ages, those diagnosed with PD were 24% less likely to actually die from cardiac-related conditions.


If you asked me to take a stab at why this relationship exists, I would begin with the fact that while few people experiencing states of panic are having an MI, almost everyone with an MI experiences panic. So I would guess that somewhere along the way, a lot of younger people with serious heart problems–and in the age of creeping obesity and poor diets, we’re seeing plenty of them–are diagnosed only with PD, their cardiac issues flying under the radar.
In fact, reaching even further into my ass, since the findings of this study relate to the comparatively young, it’s likely that the younger someone having an MI is, the less likely he is to acknowledge what’s going on, or even have a clue. No everyone presents with crushingsubsternalchestpainradiatingtoleftaxillaryregion.
So maybe a great many of those PD cases are at root cardiac-disease-driven rather than the other way around, which would explain both the increased cardiac mayhem in PD folk and the decreased risk of death–people identified early on as having CHD have access to regular, informed care from that point forward, whereas a lot of people with CHD never know it until they are older and less hale in general and have 90% occlusion in three vessels and die during their first MI. Or something.
The lead researcher, Dr. Kate Walters, seems to agree with at least some of this, but of course has broader insight:.

“Not much is known about the relationship between panic disorder and cardiac disease. The symptoms of panic attacks can closely mimic those of a heart attack or acute cardiac disease, and it seems that there may be a complex relationship between them.
“Our findings have significant implications for clinicians. Panic attacks were associated with a significant increased risk of a subsequent diagnosis of CHD and acute MI in those aged younger than 50. This may be due to initial misdiagnosis of CHD as panic attacks, or a true underlying increased risk of CHD with panic attacks. Clinicians should be vigilant for this possibility when diagnosing and treating people presenting with symptoms of panic.”
Dr Walters speculated about the possible reasons for the reduced risk of death. “This might be because the higher risk of coronary heart disease and heart attacks occurred amongst younger people who have fewer heart-related deaths generally; or it might be because people with panic disorders go to their doctors earlier and more frequently and, therefore, are more likely to have their heart disease identified and treated early, thus reducing the likelihood of dying from it.”
“These findings could be due to several factors, including initial misdiagnosis of CHD as panic attacks/disorder by GPs or due to a true increase in CHD and acute MI caused by panic disorder, potentially through activation of the sympathetic nervous system in ways that lead to clogging of the arteries and reductions in the normal variation in heart rate. This hypothesis, rather than GP misdiagnosis, is supported by the fact that we observed an increasing risk of CHD with increasing frequency of panic attacks/disorder events.
“In addition, although we made adjustments for identified depression, it is possible that some patients with panic might have had undiagnosed depression, which is also associated with an increased risk of CHD.”
“While there is a small increased risk among people diagnosed by their GP with panic attacks/disorder, the vast majority of people with panic attacks will not go on to have a heart attack or heart diseases such as angina. This is particularly the case for younger people, as the overall likelihood of heart attacks at this age is so low. For example, less than three in 10,000 men and less than two in 10,000 women under 40 diagnosed by their GP with panic attacks will go on to have a heart attack. In your 40s the risk of heart attacks is higher, but it is still less than four in 1,000 men with panic attacks and less than one in 1,000 women.
“People should be encouraged to go back to their GPs for further assessment if their symptoms continue or reoccur, and GPs should consider the possibility of CHD or MI.
“I should add that this research was based on a large database of GP records, and we do not know if any of our findings apply to people who do not consult their GPs about panic attacks.”

For some reason the European Heart Journal home page isn’t loading, so that’s all I got.

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