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Query: UMLS:C0008031 (chest pain)
 17,248 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

For phenomenological elucidation of panic attacks, 26 patients with panic attacks were requested to name the panic symptoms in order of their occurrence and specify the patterns of their abatement. Panic symptoms were found to be classifiable into three categories: early symptoms consisting of dizziness or faintness, palpitations, and sweating; intermediate symptoms dyspnea, nausea or abdominal distress, flush or chills, chest pain or discomfort, shaking, and choking; late symptoms paresthesias, fear of dying, and fear of going crazy. Panic symptoms disappeared in 61.6% irrespective of the sequence of their occurrence. Twenty-one patients were interviewed about the experience of nocturnal panic attacks, and 23.8% experienced them. These findings suggest that fear is caused by sudden physical abnormality triggered by some biological factors.
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PMID:The sequence of panic symptoms. 148 43

An 18-yr-old college freshman basketball player at a Division I university suffered chest pain, dyspnea, and dizziness followed by syncope while running a 400-m dash. After an extensive multidisciplinary workup that eliminated all organic causes, the patient, an only child from a remote rural area, was found to be suffering from panic attacks with mild features of agoraphobia. Exertional chest pain is a common complaint in young athletes. The etiologies are myriad and can be referable to many organ systems; however, the cause is usually benign. Psychogenic origin is uncommon but must be considered when organic causes have been ruled out and the patient's social history is suggestive.
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PMID:Chest pain and shortness of breath in a collegiate basketball player: case report and literature review. 156 45

Chest pain often accompanies panic attacks. The success of cognitive therapy in the treatment of panic disorder has led to effective cognitive--behavioral therapy for both anxiety about health and noncardiac chest pain accompanied by anxiety. The cognitive hypothesis proposes that, in vulnerable persons, sensations in the chest region can be misinterpreted as a sign of serious illness, such as an impending heart attack, giving rise to anxiety. A variety of responses can contribute to the problem of such misinterpretations and the associated anxiety. First, anxiety-induced autonomic arousal can generate an increase in symptoms. Second, worried patients are more likely to focus on their bodily reactions and to check their bodily functioning, increasing the likelihood that some changes will be detected. Third, patients may seek medical evaluation or other forms of reassurance, which can lead to further misinterpretation and worry. Each of these reactions can increase the perception of chest pain, contributing to a vicious cycle that exacerbates both the chest pain and the anxiety. In most cases, treatment is straightforward. It starts with identification of the patient's particular fears, followed by education about the role of anxiety in producing physical sensations such as chest pain. Demonstration of the processes that produce and maintain physical sensations usually convinces the patient of the harmless nature of symptoms. Although cognitive therapy avoids giving reassurance by "ruling out" feared diseases, patients are encouraged to take actions to disconfirm their worst fears. Some patients require more specialized treatment, particularly if they remain strongly convinced that their problem is solely physical. Such patients must be engaged in active collaboration with the therapist.
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PMID:Psychological treatment of noncardiac chest pain: the cognitive approach. 159 56

Several lines of investigation strongly support the notion that panic disorder afflicts at least one third of patients with angiographically normal coronary arteries and unexplained chest pain. Panic disorder is a common problem, affecting 1-2% of the U.S. population. Current research suggests an etiology that is both psychophysiologic and cognitive. The locus ceruleus and cortico-releasing factor are implicated in the biological circuit associated with panic attacks, while psychological research indicates that catastrophic thinking, phobic responses to somatic sensations, and repressed anger, grief, and traumatic events play a part in triggering attacks. Treatment consists of pharmacologic interventions, including antidepressants and benzodiazepines, as well as psychotherapeutic work focusing on catastrophic thinking and repressed anger, grief responses, and other traumatic experiences.
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PMID:Panic disorder in patients with angiographically normal coronary arteries. 159 62

Identifying the cause of recurrent chest pain may be difficult. Significant coronary artery disease must be excluded before patients can be assured that their symptoms are truly "noncardiac." A normal coronary angiogram is the most definitive test but this may not preclude the presence of a new "fly in the ointment," i.e., microvascular angina. Musculoskeletal pain syndromes, psychological problems, and esophageal disorders, including both esophageal motility disorders and gastroesophageal reflux disease, are the most common causes of noncardiac chest pain. Nearly 30% of these patients will have an esophageal motility disorder, although its clinical relevance in the asymptomatic patient is controversial. Simple, inexpensive, provocation tests (most commonly edrophonium, bethanechol, and/or balloon distention) have been developed to recreate motility-related chest pain in the laboratory. These tests can identify the esophagus as the source of pain, but in most cases they do not direct therapy. Other disadvantages of provocation tests include the lack of a gold standard reference point, side effects, and the need for placebo because of a subjective end point. Recently, ambulatory esophageal pH and pressure monitoring have been used to define precisely the cause of esophageal chest pain. These systems can record multiple episodes of pain for up to 24 hours in an outpatient setting and have shown that gastroesophageal reflux (rather than motility disorders) is the most common esophageal cause of pain. However, these studies also suggest that many episodes of chest pain do not have an identifiable esophageal cause. Furthermore, this equipment is expensive, uncomfortable, may alter normal activity, and is not useful in patients having infrequent pain episodes. Psychological disturbances should be carefully sought in any patient with noncardiac chest pain: Many patients have anxiety, depression, or panic attacks that may complicate or contribute to their reported symptoms. It is questionable if these patients need additional testing. Rather, the challenge of the future is to prove that the multitude of tests aid in the overall treatment and outcome of patients with noncardiac chest pain.
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PMID:Overview of diagnostic testing for chest pain of unknown origin. 159 63

However varied the clinical descriptions of anxiety, a sizeable proportion is always allotted to the cardiovascular aspect. One is reminded of Krishaber's cerebral-cardiac neuropathy and Brissaud's conception of anxiety. The implication of the heart in anxiety disorders, especially paroxystic disorder, i.e. panic attacks (PA) is important. Cardiovascular symptoms (tachycardia, increased systolic blood pressure, chest pain) are among the most frequent manifestations of panic; furthermore, recent studies suggest that male panic disorder (PD) patients have an increased mortality risk from cardiovascular diseases. It is with this implication in mind that we undertook this study, the main aim of which was to confirm the existence of an abnormal microcirculation, characteristic of PD, taking the form of an excess number of twisted capillaries. Abnormal capillaries had been described previously in non-controlled studies of patients with psychiatric disorders diagnosed as neurasthenia, neurosis, neurovegetative disorders and more recently as neurocirculatory asthenia, a syndrome similar to PD. This led us to undertake a study of the total number of capillaries observed by photomicrography (capillaroscopy) in the supra-ungueal fold of the fingers of both hands (except thumbs), comparing the number of twisted capillaries of 16 subjects suffering from panic disorder with or without agoraphobia according to the DSM III-R criteria, with those of 16 healthy volunteers matched for age and sex and 14 subjects suffering from other anxiety disorders (10 of them fulfilling criteria for generalized anxiety disorders).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Panic disorder and microcirculation. Controlled study of capillaries in anxiety disorders]. 163 1

Mitral Valve Prolapse (MVP) is a common cardiac disorder in our community. It is estimated that 4% to 15% of the general population have the anatomical defect of prolapsed mitral valve leaflets during ventricular systole. Patients with MVP that suffer from chest pain, dyspnea, fatigue, dizziness, syncope, palpitations, cardiac arrhythmias, anxiety, and panic attacks are diagnosed as having Mitral Valve Prolapse Syndrome. There is much controversy in the medical literature as to the causes of MVPS symptomatology. Some scientists believe that autonomic dysfunction, adrenergic, and vagal responsiveness are factors which appropriately explain the symptoms of MVPS. Pharmacological therapy, depending on the severity of the symptoms, is one option for treatment. Education on the etiology of their symptoms, instruction on lifestyle modifications, and reassurance from their physician are appropriate methods for the management of MVPS patients.
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PMID:Mitral valve prolapse. 186 Oct 97

Mitral valve prolapse is a common cardiac disorder that can readily be diagnosed by characteristic auscultatory and echocardiographic criteria. Although many diseases have been associated with mitral valve prolapse, most affected individuals have the primary form of the disorder. Mitral valve prolapse is an inherited condition commonly associated with myxomatous degeneration of the mitral valve and its support structures. Complications of mitral valve prolapse, including cardiac arrhythmias, sudden death, infective endocarditis, severe mitral regurgitation (with or without chordae tendineae rupture), and cerebral ischemic events, occur infrequently considering the wide prevalence of the disorder. Panic disorder is a specific type of anxiety disorder characterized by at least three panic attacks within a 3-week period or one panic attack followed by fear of subsequent panic attacks for at least 1 month. It too is a common condition with a prevalence and age and gender distribution similar to that of mitral valve prolapse. Panic disorder and mitral valve prolapse share many nonspecific symptoms, including chest pain or discomfort, palpitations, dyspnea, effort intolerance, and pre-syncope. Chest pain is the symptom in both conditions that most commonly brings the patient to medical attention. The clinical description of chest pain in patients with mitral valve prolapse is highly variable, possibly reflecting multiple etiologies. Chest pain in panic disorder is usually characterized as atypical angina pectoris and as such bears resemblance to the chest pain commonly described by patients with mitral valve prolapse. Multiple investigative attempts to elucidate the mechanism of chest pain in both conditions have failed to identify a unifying cause. Review of the literature leaves little doubt that mitral valve prolapse and panic disorder frequently co-occur. Given the similarities in their symptomatology, a high rate of co-occurrence is, in fact, entirely predictable. There is, however, no convincing evidence of a cause-effect relationship between the two disorders, nor has a single pathophysiologic or biochemical mechanism been identified that unites these two common conditions. Until specific biologic markers for these disorders are identified, it may be impossible to do so. The lack of a proven cause-and-effect relationship between mitral valve prolapse and panic disorder and the absence of a unifying mechanism do not diminish the clinical significance of the high rate of co-occurrence between the two conditions. Primary care physicians and cardiologists frequently encounter patients with mitral valve prolapse and nonspecific symptoms with no discernible objective cause who fail to respond to beta-blockade. Panic disorder should be considered as a possible explanation for symptoms in such patients.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Mitral valve prolapse, panic disorder, and chest pain. 189 9

Recurring substernal chest pain is an important clinical problem, causing anxiety for patients and their physicians because of the fear of possible cardiac disease. The differential diagnosis includes coronary artery disease, oesophageal disorders such as acid reflux disease and motility disturbances, musculoskeletal problems, psychological disorders including panic attacks, and a new 'fly in the ointment'--microvascular angina. History alone usually cannot distinguish cardiac from non-cardiac chest pain. After exclusion of significant coronary artery disease, attention must be turned to oesophageal disorders, which may be seen in as many as 50% of these patients. Oesophageal motility disorders, particularly the nutcracker oesophagus, are common, but the relationship between pain and abnormal contraction pressures is not well established. Provocative tests such as edrophonium (Tensilon) and balloon distension help to identify the oesophagus as the source of chest pain but do not direct therapy. Recent studies with ambulatory oesophageal monitoring suggest that gastro-oesophageal reflux may be a more common cause of chest pain than motility disorders. This is an important finding as acid reflux is a treatable problem, while therapies for motility disorders may only worsen reflux disease. The recent observation that oesophageal disorders are frequently associated and interact with psychological disorders such as anxiety, depression, somatization and panic attacks complicates the evaluation and understanding of chest pain. How these various abnormalities may be linked is an unresolved issue. Increased central nervous system stimulation and altered visceral and/or central pain sensitivity could be the common factors. It is hoped that further research into these areas will lead to new understandings of and possible solutions to the complex problem of non-cardiac chest pain.
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PMID:Investigation and management of non-cardiac chest pain. 191 53

A cause-and-effect relation between panic attacks and agoraphobia is an accepted concept. It is believed that, left unchecked, a subgroup of patients with panic attacks will consistently develop agoraphobia. However, to date, there are no means for early identification of this at-risk group. This study analyzed patients with panic attacks and phobic avoidance behaviors by using population-based, survey-collected data. Path analysis was used to determine relations among panic symptoms, phobic behaviors, panic-phobic lag times, and measures of pervasiveness and severity of fears and panic. Panic-related chest pain, dyspnea, trembling, and fear were important factors in the development, pervasiveness, and severity of situational fears and anticipatory anxiety. However, full-blown agoraphobia was only related to the presence of anticipatory anxiety and the pervasiveness of phobic avoidance behaviors. Although the age-of-onset of panic and phobic avoidance was unrelated to other factors, lag times were dependent upon panic symptomatology and the presence of depression. These findings suggest that patients with panic attacks who are at risk for agoraphobia can be identified by the nature of their panic symptoms, and perhaps, through early treatment, the development of phobic avoidance can be averted.
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PMID:Factors in the panic-agoraphobia transition. 275 May 61


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