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Supraventricular Distinctions, Tachycardia, and Panic Disorder

Donald F. Klein, MD
Arch Intern Med. 1997;157(13):1505. doi:10.1001/archinte.1997.00440340149017.
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Lessmeier et al1 studied 107 patients with reentrant paroxysmal supraventricular tachycardia. They state that Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, panic disorder criteria2 were fulfilled by 67% of the patients and that 54% of the patients had not received the correct diagnosis from their physicians, who attributed the patients' symptoms to panic anxiety or stress. The authors caution that diagnosis is often delayed by inappropriate rhythm detection techniques, such as using a Holter monitor instead of event monitoring and failing to recognize ventricular preexcitation on the electrocardiogram. Also, it is important to note that these incorrect diagnoses steer the patients away from a specific, effective electrophysiologically guided therapy that has proved effective in 86% of these cases.

Several question arise. Did the patient's syndrome truly mimic panic disorder, or is this a faute de mieux diagnosis? That is, if the physician cannot detect cardiac disease,


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