EMBARGOED FOR RELEASE: 3 p.m. (CT) Sunday, March 9, 1997
Media Advisory:
To contact Timothy J. Lessmeier, M.D.,
call Darlene Heizer at 509/838 7711.
Heart Rhythm Disorder Misdiagnosed as "Panic Attack" Diagnosis missed more often among female patients
A curable, recurrent rapid heart rhythm can produce symptoms similar to those of a "panic attack," causing physicians to misdiagnose the condition especially among women, according to an article in the March 10 issue of the AMA's Archives of Internal Medicine.
Timothy J. Lessmeier, M.D., formerly of Wayne State University School of Medicine, and now with Heart Clinics Northwest, Spokane, Washington, and colleagues studied 107 patients who were referred for a special heart catheterization procedure known as electrophysiologic testing. The median age of the patients was 40; 55 percent were women.
The test proved the patients suffered from a recurrent, non life threatening disorder known as paroxysmal supraventricular tachycardia (PSVT). PSVT causes a rapid heartbeat, typically 150 250 beats per minute, that often stops on its own after several seconds or minutes.
The researchers report the disorder was incorrectly diagnosed for 55 percent (59) of the patients during their initial medical evaluations. Among those unrecognized cases, a median of 3.3 years went by before the correct diagnosis was made.
A major factor in the confusion is that the heart rhythm disorder can mimic the symptoms of a "panic attack". The researchers write: "PSVT episodes occurred without warning in 98 percent of patients, and 73 percent of patients reported multiple episodes or at least one month of fear of recurrence. Panic attack symptoms were commonly reported during PSVT; 88 percent of patients experienced four or more such symptoms. In all, 67 percent of our patients fulfilled the ... criteria for panic disorder."
They report that in more than half the unrecognized cases, the initial physicians attributed symptoms to panic, anxiety or stress. The misdiagnosis was made twice as frequently for women as for men. Twelve percent of the patients who were misdiagnosed sought mental health treatment before learning they suffered from PSVT.
The researchers write that most of the patients were cured of their symptoms during a median 20 month follow up period: "Electrophysiologically guided therapy ultimately resulted in symptom resolution in 86 percent of all patients."
Treatment involved either a catheterization like procedure called "radiofrequency ablation," designed to completely eliminate the abnormality, or medication to suppress recurrences.
PSVT was correctly detected in only nine percent of patients whose initial medical evaluation included the use of the traditional portable 24 hour electrocardiogram recorder. The researchers found "event monitors" to be far more effective, detecting PSVT in nearly half the patients who used them. Event monitors are lightweight recording devices, usually worn for a week or two, and activated by the patient when he or she experiences palpitations or other symptoms.
The researchers conclude: "Symptoms due to PSVT frequently fulfill the formal psychiatric criteria for panic disorder ... PSVT recognition may be delayed for years, and when unrecognized, symptoms of PSVT were frequently attributed by physicians (nonpsychiatrists) to panic, anxiety or stress especially in women." With the availability of therapy for PSVT, they suggest that "if this diagnosis is aggressively sought and identified, patients with panic attacks due to these arrhythmias may be cured."
#
For more information: contact the AMA's Science News Department at 312/464 5374. AMA web site: http://www.ama assn.org
RSS