Katerndahl David A
Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
Prim Care Companion J Clin Psychiatry. 2008;10(5):376-83. doi: 10.4088/pcc.v10n0505.
Chest pain is a common symptom in primary care settings, associated with considerable morbidity and health care utilization. Failure to recognize panic disorder as the source of chest pain leads to increased health care costs and inappropriate management.
To identify characteristics of the chest pain associated with the presence of panic disorder, review the consequences and possible mechanisms of chest pain in panic disorder, and discuss the recognition of panic disorder in patients presenting with chest pain.
Potential studies were identified via a computerized search of MEDLINE and PsycINFO databases and review of bibliographies. MeSH headings used included panic disorder with chest pain, panic disorder with coronary disease or cardiovascular disorders or heart disorders, and panic disorder with cholesterol or essential hypertension or tobacco smoking.
The diagnosis of panic disorder in eligible studies was based on DSM criteria, and studies must have used objective criteria for coronary artery disease and risk factors. Only case control and cohort studies were included.
Although numerous chest pain characteristics (believed to be both associated and not associated with coronary artery disease) have been reportedly linked to panic disorder, only nonanginal chest pain is consistently associated with panic disorder (relative risk = 2.03, 95% CI = 1.41 to 2.92).
Chest pain during panic attacks is associated with increased health care utilization, poor quality of life, and phobic avoidance. Because the chest pain during panic attacks may be due to ischemia, the presence of panic attacks may go unrecognized. Ultimately, the diagnosis of panic disorder must be based on DSM criteria. However, once panic disorder is recognized, clinicians must remain open to the possibility of co-occurring coronary artery disease.
胸痛是基层医疗环境中的常见症状，与相当高的发病率和医疗保健利用率相关。未能将惊恐障碍识别为胸痛的根源会导致医疗保健成本增加和管理不当。
确定与惊恐障碍相关的胸痛特征，回顾惊恐障碍中胸痛的后果和可能机制，并讨论在出现胸痛的患者中识别惊恐障碍。
通过对MEDLINE和PsycINFO数据库进行计算机检索以及查阅参考文献来确定潜在研究。使用的医学主题词包括伴有胸痛的惊恐障碍、伴有冠状动脉疾病或心血管疾病或心脏病的惊恐障碍以及伴有胆固醇或原发性高血压或吸烟的惊恐障碍。
符合条件的研究中惊恐障碍的诊断基于《精神疾病诊断与统计手册》（DSM）标准，且研究必须对冠状动脉疾病和危险因素使用客观标准。仅纳入病例对照研究和队列研究。
尽管据报道许多胸痛特征（被认为与冠状动脉疾病有关和无关）都与惊恐障碍有关，但只有非心绞痛性胸痛始终与惊恐障碍相关（相对风险 = 2.03，95%置信区间 = 1.41至2.92）。
惊恐发作时的胸痛与医疗保健利用率增加、生活质量差和恐惧回避有关。由于惊恐发作时的胸痛可能是由于缺血引起的，惊恐发作可能未被识别。最终，惊恐障碍的诊断必须基于DSM标准。然而，一旦识别出惊恐障碍，临床医生必须对同时存在冠状动脉疾病的可能性持开放态度。
