Background
Chest pain, a key element in the investigation of coronary artery disease is often
regarded as a benign prognosis when present in panic attacks. However, panic disorder
has been suggested as an independent risk factor for long-term prognosis of cardiovascular
diseases and a trigger of acute myocardial infarction.
Objective
Faced with the extreme importance in differentiate from ischemic to non-ischemic chest
pain, we report a case of panic attack induced by inhalation of 35% carbon dioxide
triggering myocardial ischemia, documented by myocardial perfusion imaging study.
Discussion
Panic attack is undoubtedly a strong component of mental stress. Patients with coronary
artery disease may present myocardial ischemia in mental stress response by two ways:
an increase in coronary vasomotor tone or a sympathetic hyperactivity leading to a
rise in myocardial oxygen consumption. Coronary artery spasm was presumed to be present
in cases of cardiac ischemia linked to panic disorder. Possibly the carbon dioxide
challenge test could trigger myocardial ischemia by the same mechanisms.
Conclusion
The use of mental stress has been suggested as an alternative method for myocardial
ischemia investigation. Based on translational medicine objectives the use of CO2
challenge followed by Sestamibi SPECT could be a useful method to allow improved application
of research-based knowledge to the medical field, specifically at the interface of
PD and cardiovascular disease.