Managing Panic Disorder: When to Consult a Cardiologist?

I have issues with panic disorder?

For the past two years, I have been troubled by palpitations and chest tightness.
About two years ago, I underwent an electrocardiogram (ECG), a 24-hour Holter monitor, and an echocardiogram, but no abnormalities were found.
Later, I learned that autonomic nervous system dysregulation could also lead to palpitations and chest tightness, so I sought treatment from a psychiatrist and was diagnosed with panic disorder.
I have been continuously taking antidepressants for over a year.
However, my palpitations have not improved, and I have recently been feeling increasingly uncomfortable.
After undergoing an echocardiogram last week, I was informed that I have tricuspid valve prolapse.
Since the doctor who evaluated me is a psychiatrist, he did not provide any recommendations.
Therefore, I would like to ask you whether I should continue treatment with the psychiatrist, and if there is a need to see a cardiologist.

Ginny, 10~19 year old female. Ask Date: 2004/12/27

Dr. Tang Xinbei reply Psychiatry

Dear Ginny,
It seems that your panic disorder has been troubling you for quite some time, and there appears to have been some changes recently? Generally speaking, the most effective treatment for panic disorder currently involves a combination of pharmacotherapy and cognitive behavioral therapy.
After long-term follow-up, approximately one-third of individuals will recover; about half will continue to experience mild symptoms that do not significantly impact their daily lives; one-fifth will persist with severe symptoms; and more than half of patients may also have comorbid depression.
The use of antidepressants can not only improve panic disorder but also alleviate depressive symptoms, so it is recommended that you continue to see a psychiatrist.
Although there is currently insufficient evidence to establish a direct correlation, some patients with panic disorder also have issues related to heart valve abnormalities, such as tricuspid valve prolapse or mitral valve prolapse.
Due to these valve prolapses, patients may experience reduced cardiac function, which can often lead to palpitations.
Common physiological symptoms include tachycardia, palpitations, shortness of breath, and sweating.
It is advisable for you to discuss this with both a psychiatrist and a cardiologist to assess whether ongoing cardiology follow-up is necessary.
Wishing you peace and joy!

Reply Date: 2004/12/27

More Info

When managing panic disorder, especially when accompanied by symptoms such as palpitations and chest tightness, it is crucial to approach the situation holistically. Your history of panic disorder, coupled with the recent diagnosis of tricuspid valve prolapse, raises several important considerations regarding your ongoing treatment and the need for cardiology consultation.

Firstly, it is essential to understand that panic disorder can indeed manifest with physical symptoms that mimic cardiac issues. Symptoms such as palpitations, chest tightness, and shortness of breath are common in individuals experiencing panic attacks. These symptoms can be distressing and may lead to increased anxiety, creating a vicious cycle that exacerbates both the panic disorder and the perception of cardiac problems.
Given that you have undergone thorough cardiac evaluations, including an electrocardiogram (ECG), 24-hour Holter monitoring, and echocardiography, and that these tests have not revealed significant abnormalities aside from the tricuspid valve prolapse, it is reasonable to consider that your symptoms may be more related to anxiety than to a serious cardiac condition. Tricuspid valve prolapse is a relatively common finding and, in many cases, does not lead to significant clinical issues or require intervention unless accompanied by severe regurgitation or other complications.

However, the persistence of your symptoms and the recent worsening of your discomfort warrant a careful reassessment. It is advisable to consult a cardiologist, particularly because of the following reasons:
1. Evaluation of Tricuspid Valve Prolapse: While tricuspid valve prolapse is often benign, it can sometimes lead to complications such as regurgitation. A cardiologist can provide a detailed assessment of the severity of your prolapse and whether it is contributing to your symptoms.

2. Reassurance and Management: A cardiologist can help reassure you about your heart health, which may alleviate some of the anxiety associated with your symptoms. They can also provide guidance on lifestyle modifications or treatments that may help manage both your cardiac and anxiety symptoms.

3. Coordination of Care: Since you are already receiving treatment for panic disorder, it is beneficial for your mental health provider to collaborate with a cardiologist. This multidisciplinary approach can ensure that both your psychological and physical health needs are addressed comprehensively.

4. Symptom Management: If your palpitations and chest discomfort persist, a cardiologist can explore additional management strategies, including medication adjustments or further testing if necessary.

In conclusion, while it is important to continue your treatment for panic disorder with your psychiatrist, consulting a cardiologist is also advisable given your recent symptoms and the diagnosis of tricuspid valve prolapse. This dual approach will help ensure that both your mental and physical health are being adequately managed. Remember, it is always better to err on the side of caution when it comes to heart health, and having a thorough evaluation can provide peace of mind and potentially improve your overall well-being.

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