A study of myocardial perfusion in patients with panic disorder and low risk coronary artery disease after 35% CO2 challenge

J Psychosom Res. 2014 Jan;76(1):41-5. doi: 10.1016/j.jpsychores.2013.08.003. Epub 2013 Aug 15.


Background: We have previously reported that 35% CO2 challenge induced myocardial ischemia in 81% of coronary artery disease (CAD) patients with comorbid panic disorder (PD) and previous positive nuclear exercise stress tests. However, it is yet unclear whether this is the case among CAD patients with PD and normal nuclear exercise stress test results. We hypothesized that a potent mental stressor such as a panic challenge among CAD patients with PD would also induce ischemia in patients with normal exercise stress tests.

Methods: Forty-one coronary artery disease patients with normal nuclear exercise stress tests (21 patients with PD and 20 without PD) were submitted to a well-established panic challenge test (with 1 vital capacity inhalation of a gas mixture containing 35% CO2 and 65% O2) and injected with Tc-99m-tetrofosmin (Myoview), upon inhalation. Single photon emission computed tomography imaging was used to assess per-panic challenge reversible myocardial ischemia and HR, BP, and a 12 lead ECG was continuously measured during the procedure.

Results: Fifty-eight percent of panic disorder patients (12/21) had a panic attack during the panic challenge vs 15% (3/20) of controls (p=0.005). Only 10% of patients in each group displayed myocardial ischemia per panic challenge.

Conclusions: These findings suggest that panic attacks among panic disorder patients with lower-risk coronary artery disease may not confer a risk for myocardial ischemia.

Keywords: Coronary artery disease; Exercise stress test; Myocardial ischemia; Myocardial perfusion defects; Panic attacks; Panic disorder.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Inhalation
  • Adult
  • Aged
  • Carbon Dioxide* / administration & dosage
  • Coronary Artery Disease / complications*
  • Coronary Artery Disease / psychology
  • Exercise Test
  • Female
  • Humans
  • Male
  • Middle Aged
  • Myocardial Ischemia / psychology*
  • Organophosphorus Compounds
  • Organotechnetium Compounds
  • Panic Disorder / complications*
  • Panic*
  • Radiopharmaceuticals
  • Risk
  • Tomography, Emission-Computed, Single-Photon* / methods


  • Organophosphorus Compounds
  • Organotechnetium Compounds
  • Radiopharmaceuticals
  • Carbon Dioxide
  • technetium tc-99m tetrofosmin