Cardiovascular Manifestations of Panic and Anxiety

Anxiety disorders are prevalent in 10–23% of persons with coronary heart disease (CHD) and are therefore quite commonly encountered in typical cardiology practice settings. Because anxiety disorder patients frequently present to emergency departments and outpatient appointments for atypical cardiovascular symptoms, the accurate identification and treatment of anxiety is therefore a major priority for all persons involved in cardiovascular care. The substantial overlap in subjective cardiorespiratory symptoms shared between anxiety and cardiovascular diseases does little to improve our understanding of this complex association. Herein we describe the complex nature of anxiety disorders such as panic disorder in relation to CHD. Particular attention is paid to overviewing the empirical evidence demonstrating aetiological and prognostic links between anxiety disorders with incident and recurrent cardiovascular diseases, respectively. We also discuss potential biobehavioral mechanisms that lead to atherosclerosis and major cardiovascular event recurrence. This chapter also discusses the extant treatment approaches to anxiety, making suggestions for improving clinical interventions in the population with anxiety and comorbid CHD. After summarizing these facets of the anxiety-CHD link, suggestions are made for future research.