FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

["PANIC ATTACKS" CAN CAUSE HEART-ATTACK LIKE CHEST PAIN]

Question: The emergency squad took me to the hospital because I was having chest pain. After several hours and many tests, they told me that the pain was caused by my emotions, not by my heart. I'm glad that my heart checked out OK, but I'm not sure I believe their diagnosis. How can emotions cause chest pain?

Answer: Chest pain is a rather non-specific symptom. That is, a number of conditions cause it. Most people have been taught to think about a heart attack at the first hint of chest pain. This is a sensible precaution because heart disease is still the leading cause of death, and prompt medical attention is essential for a favorable outcome. Fortunately though, many other conditions can also cause chest pain.

Lung problems, disorders of the esophagus, stomach ulcers, gallstones and anxiety are a few of the conditions that can cause chest pain. We doctors often face the difficult task of identifying the cause of pain when the history and physical exam fail to give strong evidence of one cause or another. Since heart trouble is quite common and also quite serious, we check that out first. That is what the emergency department physician did for you.

Emotional disorders, specifically a form of anxiety called a panic attack, can cause symptoms that are the same as a heart attack: chest pain, left arm pain, shortness of breath, sweating, and a sense of foreboding. It is estimated that every year 35 percent of the population has at least one panic attack. Wow! That's a lot of anxious moments. Most begin suddenly and end within 30 minutes. Not all of these attacks have the same symptoms as a heart attack, as yours did, but many do.

A panic attack is actually a symptom of anxiety, rather than a disorder, in and of itself. Usually this anxiety is "self-limiting" and most panic attacks are isolated events. However, in less than one percent of the population, these attacks occur repeatedly and, thereby, cause significant disruption in the lives of the sufferer and his or her loved ones.

Some experts believe that panic attacks are a consequence of a biochemical imbalance in the brain. The significant reduction or elimination of panic episodes with the use of antidepressant and anxiety reducing medicines supports this hypothesis. In addition to drug treatment, counseling particularly cognitive-behavior therapy can be quite effective.

Individuals experiencing only one panic attack may need no additional treatment other than the awareness that they are stressed to their emotional limit. They are then able to focus their attention on the "stressors" in their life and make appropriate changes. Many others, however, who experience repeated attacks, require counseling and medication to effectively cope with the anxiety causing situations.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.