Panic Disorder vs. Cardiac Arrhythmia: Exploring the Etiology of Palpitations and Panic Attacks through ECG Analysis

Palpitations are a common complaint in clinical practice, and their etiology can vary widely, ranging from benign causes to potentially serious conditions. Two of the most frequent causes that must be considered are panic disorder and cardiac arrhythmia. Differentiating between these two conditions is crucial for the appropriate management of the patient.

Exploring the Etiology of Palpitations

Panic disorder is a psychiatric condition that often presents with somatic symptoms, including palpitations, which can be confused with cardiac issues. Studies have shown that a significant percentage of patients presenting with chest pain or palpitations in a cardiology emergency setting actually suffer from undiagnosed panic disorder [1]. Furthermore, the therapeutic response in these patients may be related to central mechanisms rather than heart rate variability [2].

On the other hand, cardiac arrhythmias can present with similar symptoms, such as palpitations and dizziness. However, cardiac evaluation, including ECG and Holter monitoring, is essential to identify arrhythmias that require treatment [3]. In some cases, underlying cardiac conditions, such as cardiac sarcoidosis, may mimic panic disorder, highlighting the importance of a thorough evaluation [4].

Conclusions

The differentiation between panic disorder and cardiac arrhythmia in patients with palpitations is fundamental to avoid misdiagnoses and inadequate treatments. A multidisciplinary approach that includes both psychiatric and cardiological evaluations can significantly improve the management of these patients. Accurate identification of the etiology of palpitations not only enhances the patient's quality of life but also optimizes the use of medical resources.

Referencias

• [1] Panic disorder in patients with chest pain and palpitations: an often unrecognized relationship.
• [2] Correlates of therapeutic response in panic disorder presenting with palpitations: heart rate variability, sleep, and placebo effect.
• [3] Cardiac and psychiatric diagnoses among patients referred for chest pain and palpitations.
• [4] Cardiac sarcoidosis resembling panic disorder: a case report.

Created 6/1/2025