I read with interest the case report by Irfan and colleagues
1
on purported coronary microvascular spasm and panic attack during a functional coronary
angiogram. The patient did not stop her calcium channel blocker on the day of procedure.
This could confound the procedure: that is, blunting either coronary epicardial or
microvascular spasm if acetylcholine was given, which it was not, nor was adenosine
administered. How, then, was the coronary flow reserve (CFR) of 1.9 derived? CFR is
a hyperaemic index, and this value suggests impaired vasodilatory capacity.To read this article in full you will need to make a payment
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References
- Association between panic attack and coronary ischemia due to reduction in coronary blood flow.Can J Cardiol. 2023; 39: 71-72
- Coronary hemodynamics.in: Stouffer G.A. Cardiovascular Hemodynamics for the Clinician. Blackwell Publishing, Hoboken, NJ2008: 233-324
Article info
Publication history
Published online: March 03, 2023
Publication stage
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Crown Copyright © 2023 Published by Elsevier Inc. on behalf of the Canadian Cardiovascular Society. All rights reserved.
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- Association Between Panic Attack and Coronary Ischemia Due to Reduction in Coronary Blood FlowCanadian Journal of CardiologyVol. 39Issue 1
- PreviewChest 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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