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Canadian Journal of Cardiology

Association Between Panic Attack and Coronary Ischemia Due to Reduction in Coronary Blood Flow

  • Saim Irfan
    Affiliations
    UCD School of Medicine, University College Dublin, Belfield, Dublin, Ireland

    Division of Cardiology, Southlake Regional Health Centre, Newmarket, Ontario, Canada
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  • Mary McCarthy
    Correspondence
    Corresponding author: Mary McCarthy, 596 Davis Drive, Newmarket, Ontario L3Y 2P9, Canada. Tel.: +1-905-895-4521.
    Affiliations
    Division of Cardiology, Southlake Regional Health Centre, Newmarket, Ontario, Canada
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  • Steven Miner
    Affiliations
    Division of Cardiology, Southlake Regional Health Centre, Newmarket, Ontario, Canada

    School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada

    Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Published:September 09, 2022DOI:https://doi.org/10.1016/j.cjca.2022.09.005
      Chest pain is a common symptom of panic attacks, but the mechanism remains unclear. We present a novel case study of the invasive assessment of coronary blood flow during and following treatment of an acute panic attack. The patient’s coronary blood flow was measured during a panic attack and after panic resolution following administration of fentanyl and midazolam. Results indicate a near doubling of coronary blood flow after resolution of panic attack, with no evidence of epicardial spasm. This study demonstrates that chest pain during panic attack is associated with decreased coronary blood flow caused by acute emotionally induced microvascular vasoconstriction.
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