Chest pain, palpitations and panic

doi:10.1016/S0022-3999(97)00209-2

Journal of Psychosomatic Research

Volume 44, Issue 1, January 1998, Pages 53-70

https://doi.org/10.1016/S0022-3999(97)00209-2 Get rights and content

Abstract

Chest pain and palpitations are commonly described in the general population and are frequent presenting symptoms in all medical settings. Although often transient, they can be persistent and are associated with considerable disability, distress, and concern about heart disease and use of medical resources. Both symptoms are associated with panic but also with other psychiatric disorders. It is most useful to consider etiology as multicausal and interactive; psychological factors affect interpretation of bodily perceptions and have deleterious effects on quality of life and use of medical resources. There is evidence that general measures and specific drug and psychological treatments can be effective. There is still uncertainty about the most appropriate ways of providing effective care to large numbers of patients.

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Cited by (74)

A Prospective Study of Noncardiac Chest Pain-Related Disability in Emergency Department Patients With Comorbid Anxiety Disorders
2024, Journal of the Academy of Consultation-Liaison Psychiatry
This study aimed to prospectively document the association between panic disorder (PD) or generalized anxiety disorder (GAD) and noncardiac chest pain (NCCP)-related disability. Its second objective was to validate an explanatory model of these associations.
This was a prospective cohort study of 124 emergency department patients with NCCP and comorbid PD or GAD. Anxiety sensitivity, heart-focused anxiety, and alexithymia were assessed at baseline. NCCP-related disability was assessed at baseline and at the 6-month follow-up. Mediation analysis was used to validate the explanatory model.
The rate of NCCP-related disability was 54.8% (n = 68) at baseline and 34.7% (n = 43) at the 6-month follow-up. Patients with PD were significantly more likely to report NCCP-related disability at the 6-month follow-up than those with GAD alone (P = 0.021). A simplified model containing a causal chain between anxiety, anxiety sensitivity, heart-focused anxiety, and NCCP-related disability at the 6-month follow-up was a good fit for the data.
PD appears to be more closely associated with NCCP-related disability than GAD. Among patients with NCCP and comorbid PD or GAD, heart-focused anxiety was the main psychological determinant of the development or maintenance of NCCP-related disability in the 6 months following an emergency department visit.
Evidence-Based Approach to Palpitations
2021, Medical Clinics of North America
Clinical Approach to Patients with Palpitations
2018, Cardiac Electrophysiology Clinics
Citation Excerpt :
Outside of such situations, instead, palpitations are considered to be pathologic.1–5 The mechanisms underlying palpitations are somewhat heterogeneous: contractions of the heart that are too rapid, irregular, or particularly slow, as in cardiac rhythm disorders or in sinus tachycardia secondary to mental disturbance, systemic diseases, or the use of pharmaceutical drugs; very intense contractions and anomalous movements of the heart in the chest, as in the case of some structural heart diseases associated with cardiomegaly and/or increased stroke volume; and anomalies in the subjective perception of the heartbeat, whereby a sinus rhythm, sinus tachycardia, or minimal irregularities in the cardiac rhythm are felt by the patient and are poorly tolerated, as in the case of some psychiatric disorders.1–7 With regard to duration, palpitations may be either paroxysmal or persistent.
Heart-focused anxiety and health care seeking in patients with non-cardiac chest pain: A prospective study
2018, General Hospital Psychiatry
This study aimed to estimate the incidence of medical consultations six months after an emergency department (ED) consultation for non-cardiac chest pain (NCCP). It also investigated the role of heart-focused anxiety (HFA) and other factors in predicting an increased healthcare utilization in these patients.
This was a prospective study of 428 patients who came to an ED with NCCP. Patients completed an interview and questionnaires assessing HFA, psychological distress, the characteristics of NCCP, and comorbidities. Their medical consultations were assessed by telephone interview six months later. The contribution of each factor was assessed using a binomial negative regression.
Eighty-three percent of patients reported at least one medical consultation (mean = 3.1, standard deviation = 3.9). HFA (incident rate ratio 1.01; 95% CI, 1.00–1.02), the presence of a medical condition (2.14; 1.51–3.03), NCCP frequency (1.49; 1.16–1.91) and NCCP-related interference (1.08; 1.04–1.13) were predictive of further medical consultations.
A significant proportion of patients with NCCP are at risk of multiple medical consultations following discharge from the ED. HFA appears as a determinant of medical consultations after controlling for multiple confounding factors.
Heart palpitation relief with Melissa officinalis leaf extract: Double blind, randomized, placebo controlled trial of efficacy and safety
2015, Journal of Ethnopharmacology
Citation Excerpt :
Palpitation is defined as an abnormal, unpleasant or heightened awareness of heartbeat (Brugada et al., 1993; Khamis and Dancy, 2009; Mayou et al., 2003; Zimetbaum and Josephson, 1998). It is the second most common reason in general practice for which patients are referred to a cardiologist (Mayou, 1998). Some palpitations may be an indication of life-threatening cardiac arrhythmias (Weber and Kapoor, 1996), but the condition is most often benign (Abbott, 2005).
In Traditional Iranian Medicine (TIM), Melissa officinalis L. is commonly regarded as an effective therapy for heart palpitations.
Heart palpitation is a common complaint that is often benign and associated with a marked distress that makes the condition difficult to treat. Herbal medicines provide an alternative to conventional drugs for treating various kinds of diseases. This study was done as a double blind randomized placebo-controlled clinical trial to evaluate the efficacy and safety of the dried extract of M. officinalis on adults suffering from benign palpitations.
Eligible volunteers were randomly assigned as outpatients to a 14 day treatment with 500 mg twice a day of lyophilized aqueous extract of M. officinalis leaves (or placebo). Participants in the tests, physicians and researchers were blind to group assignments. Both primary and secondary outcomes were patient-reported. Primary outcomes were obtained from two measures: mean frequency of palpitation episodes per week, derived from patients׳ diaries, and mean intensity of palpitation estimated through Visual Analogue Scale (VAS) in a self-report questionnaire. Psychiatric symptoms (somatization, anxiety and insomnia, social dysfunction and severe depression) were evaluated as secondary outcomes by General Health Questionnaire-28 (GHQ-28), before and after intervention.
Fifty-five volunteers out of 71 recruited study subjects completed the trial. Results showed that 14-day of treatment with lyophilized aqueous extract of M. officinalis leaves reduced frequency of palpitation episodes and significantly reduced the number of anxious patients in comparison to the placebo (P=0.0001, P=0.004 resp.). Also, M. officinalis extract showed no indication of any serious side effects.
Lyophilized aqueous extract of M. officinalis leaves may be a proper and safe herbal drug for the treatment of benign palpitations.
Diagnostic protocol of palpitations
2013, Medicine (Spain)
Las palpitaciones son una de las causas más frecuentes de atención médica en Urgencias y es el síntoma principal de consulta al médico de familia. Los pacientes las describen como una sensación desagradable de la pulsación habitualmente en la región torácica anterior, que en ocasiones se puede acompañar de otros síntomas como ansiedad, disconfort o incluso dolor torácico. El espectro etiológico es muy amplio, y abarca desde el estrés emocional hasta la taquicardia ventricular que ocasiona parada cardiorrespiratoria. Frecuentemente tienen un origen cardiológico (arritmias cardiacas con o sin cardiopatía estructural), siendo en este tipo de pacientes la ablación percutánea el tratamiento definitivo en muchas ocasiones. Dentro de las causas extracardiacas y por orden de frecuencia, debemos incluir psicosomáticas, metabólicas y farmacológicas o toxicológicas. La historia clínica, la exploración física y el registro electrocardiográfico nos ayudarán al diagnóstico definitivo y orientarán por tanto el tratamiento.
Palpitations are among the most common symptoms that prompt patients to consult general practitioners, cardiologists, or emergency healthcare services. Patients describe palpitations as a disagreeable sensation of pulsation or movement in the chest and/or adjacent areas which may be associated with discomfort, alarm, and less commonly pain. The etiologic expectro is vast, ranging from emotional stress to ventricular tachycardia causing cardiac arrest. Often palpitations have a cardiac origin (cardiac arrhythmias with or without structural heart disease), being percutaneous ablationthe definitive treatment in many cases. In order of frequency, extracardiac causes include psychosomatic, metabolic and pharmacological or toxicological. The clinical history, physical examination, and ECG recording will help to guide definitive diagnosis and treatment.

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ReviewChest pain, palpitations and panic

Abstract

Adv Behav Res Ther

Behav Res Ther

Bio Psychiatry

J Psychosom Res

Bailliere's Clin Gastroenterol

Prog Cardiovasc Dis

J Psychosom Res

Psychosomatics

Am J Cardiol

Am J Med

Am J Med

J Psychosom Res

J Psychosom Res

Am J Med

J Am Coll Cardiol

Am J Cardiol

Lancet

Br Heart J

Am J Med

Chest pain and palpitations

Invited review: atypical chest pain

J Psychosom Res

Unrecognised prevalence of panic disorder in primary care, internal medicine and cardiology

Am J Cardiol

Ideational components of anxiety

Their origin and content

Br J Psychiatry

Cardiac rate and rhythm in panic patients

Am J Psychiatry

Ambulatory heart rate changes in patients with panic attacks

Am J Psychiatry

Awareness of cardiac function in anxious, phobic and hypochondriacal patients

Psychol Med

Depression, antidepressants and accidents

Pharmacological concerns need epidemiological elucidation

BMJ

Panic and prolapse: meta-Analysis

J Nerv Ment Dis

Treatment of functional somatic symptoms

Review
Chest pain, palpitations and panic