Association Between Panic Attack and Coronary Ischemia Due to Reduction in Coronary Blood Flow

Chest pain is a common symptom of panic attacks, but the mechanism remains unclear. We present a novel case study of the invasive assessment of coronary blood flow during and following treatment of an acute panic attack. The patient’s coronary blood flow was measured during a panic attack and after panic resolution following administration of fentanyl and midazolam. Results indicate a near doubling of coronary blood flow after resolution of panic attack, with no evidence of epicardial spasm. This study demonstrates that chest pain during panic attack is associated with decreased coronary blood flow caused by acute emotionally induced microvascular vasoconstriction.