Letters to the Editor|Articles in Press

Does Panic Attack Causes Coronary Microvascular Spasm?

Published:March 03, 2023DOI:
      I read with interest the case report by Irfan and colleagues
      • Irfan S.
      • McCarthy M.
      • Miner S.
      Association between panic attack and coronary ischemia due to reduction in coronary blood flow.
      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.
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        • Irfan S.
        • McCarthy M.
        • Miner S.
        Association between panic attack and coronary ischemia due to reduction in coronary blood flow.
        Can J Cardiol. 2023; 39: 71-72
        • McLaughlin D.P.
        • Wu S.S.
        • Stouffer G.A.
        Coronary hemodynamics.
        in: Stouffer G.A. Cardiovascular Hemodynamics for the Clinician. Blackwell Publishing, Hoboken, NJ2008: 233-324

      Linked Article

      • Association Between Panic Attack and Coronary Ischemia Due to Reduction in Coronary Blood Flow
        Canadian Journal of CardiologyVol. 39Issue 1
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          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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