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| |  Curable Heart Rhythm Disorder Can Mimic 'Panic Attack' DETROIT, March 9, 1997 -- Sinai Hospital reports a non-life threatening, but often debilitating, recurrent rapid heart rhythm produces symptoms easily confused with "panic attacks" -- a misdiagnosis made twice as frequently in women. Recognition and appropriate treatment of the cardiac disorder can eliminate panic-like symptoms in 90% of cases. These new findings are being reported in the March 10, 1997 issue of the American Medical Association journal Archives of Internal Medicine by a Wayne State University School of Medicine research team, whose senior member is Michael H. Lehmann, M.D., Clinical Associate Professor of Medicine and Director of the Arrhythmia Center at Sinai Hospital, Detroit, MI. The lead author of the article is Timothy J. Lessmeier, M.D., currently at the Heart Institute of Spokane, Spokane, WA. The researchers studied 107 patients (median age 40 years; 55% women) referred for electrophysiologic testing, a special heart catheterization procedure for rhythm problems. This test proved that the patients suffered from paroxysmal supraventricular tachycardia (PSVT) -- a recurrent, non-life threatening heart rhythm disorder (typically 150-250 beats per minute) that often stops on its own after several seconds to minutes. At the time of physician contact, however, the diagnosis of PSVT was made in only 48 (45%) of patients. Among the 59 initially unrecognized cases of PSVT, a median of 3.3 years elapsed until the proper diagnosis was made. Prior to that time, symptoms in 32 (54%) of these unrecognized cases of PSVT The potential for symptom overlap between PSVT and panic attack was striking. Of the 107 patients studied, two thirds had a PSVT episode frequency and symptom profile that met American Psychiatric Association criteria for Panic Disorder. Following the electrophysiology test, PSVT was treated either by another catheterization-like procedure designed to completely eliminate the abnormality called "radiofrequency ablation," or by medication aimed at suppressing recurrences. After a median 20 month follow-up period, 86% of patients were cured of their symptoms -- including 91% of those whose symptoms were attributed to "panic," "anxiety" or "stress." The fleeting nature and relative infrequency of PSVT episodes likely contributed to such initial misdiagnoses. Even the traditional portable 24-hour electrocardiogram recorder succeeded in catching a PSVT episode in only 9% (6 of 64) patients having this test. Far more effective, the researchers found, were "event monitors" which detected PSVT in 47% (8 of 17) patients so tested. An event monitor is a lightweight electrocardiogram recording device that is typically worn (like a beeper or wrist watch) over a 1-2 week period, and activated by the patient whenever he or she has palpitations or other symptoms. Also potentially helpful is a subtle suggestive marker of a tendency toward PSVT, called a "delta wave," which sometimes may be evident on a standard electrocardiogram. However, this diagnostically valuable clue was not initially recognized in over one third of the patients with this telltale electrocardiographic sign. The study's findings should help physicians to avoid overlooking PSVT -- a curable heart rhythm disorder -- as the basis for recurrent "panic"-like symptoms, especially in women. Research is now needed to define the proportion of patients with panic attacks actually suffering from PSVT. Sinai is a 598-bed hospital located in northwest Detroit, with 11 health centers and 35 medical offices in Wayne and Oakland counties. Established by Detroit's Jewish community in 1953, Sinai serves patients throughout metropolitan Detroit.
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