Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2017 Jan 13;17(1):14.
doi: 10.1186/s12888-016-1184-z.

Cardiac sarcoidosis resembling panic disorder: a case report

Keita Tokumitsu  1 , Jun Demachi  2 , Yukichi Yamanoi  2 , Shigeto Oyama  2 , Junko Takeuchi  3 , Koji Yachimori  3 , Norio Yasui-Furukori  4
Affiliations
Case Reports

Cardiac sarcoidosis resembling panic disorder: a case report

Keita Tokumitsu et al. BMC Psychiatry. .

Abstract

Background: Sarcoidosis is a systemic disease of unknown etiology, in which granulomas develop in various organs, including the skin, lungs, eyes, or heart. It has been reported that patients with sarcoidosis are more likely to develop panic disorder than members of the general population. However, there are many unknown factors concerning the causal relationship between these conditions.

Case presentation: We present the case of a 57-year-old woman who appeared to have panic disorder, as she experienced repeated panic attacks induced by transient complete atrioventricular block, associated with cardiac sarcoidosis. Psychotherapy and pharmacotherapy were not effective in the treatment of her panic attacks. However, when we implanted a permanent pacemaker and initiated steroid treatment for cardiac sarcoidosis, panic attacks were ameliorated. Based on these findings, we diagnosed the patient's symptoms as an anxiety disorder associated with cardiac sarcoidosis, rather than panic disorder.

Conclusions: This report highlights the importance of considering cardiac sarcoidosis in the differential diagnosis of panic disorder. This cardiac disease should be considered especially in patients have a history of cardiac disease (e.g., arrhythmia) and atypical presentations of panic symptoms. Panic disorder is a psychiatric condition that is typically diagnosed after other medical conditions have been excluded. Because the diagnosis of sarcoidosis is difficult in some patients, caution is required. The palpitations and symptoms of heart failure associated with cardiac sarcoidosis can be misdiagnosed as psychiatric symptoms of panic disorder. The condition described in the current case study appears to constitute a physical disease, the diagnosis of which requires significant consideration and caution.

Keywords: Anxiety disorder; Cardiac sarcoidosis; Panic attacks; Panic disorder.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
The onset of panic attack symptoms was consistent with electrocardiographic abnormalities. A 24-h ambulatory electrocardiogram revealed cardiac pause (maximal 32 s) due to a complete atrioventricular block, and transient sinus tachycardia following recovery from the pause. The onset of panic attack symptoms was consistent with these electrocardiographic abnormalities
See this image and copyright information in PMC

References

    1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington: American Psychiatric Publishing; 2013.
    1. Iannuzzi MC, Rybicki BA, Teirstein AS. Sarcoidosis. New Engl J Med. 2007;357(21):2153–2165. doi: 10.1056/NEJMra071714. - DOI - PubMed
    1. Goracci A, Fagiolini A, Martinucci M, Calossi S, Rossi S, Santomauro T, Mazzi A, Penza F, Fossi A, Bargagli E, et al. Quality of life, anxiety and depression in sarcoidosis. Gen Hosp Psychiatry. 2008;30(5):441–445. doi: 10.1016/j.genhosppsych.2008.04.010. - DOI - PubMed
    1. Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):617–627. doi: 10.1001/archpsyc.62.6.617. - DOI - PMC - PubMed
    1. Japan Society of Sarcoidosis and Granulomatous Disorders Diagnostic standard and guidelines for sarcoidosis. Jpn J Sarcoidosis Granulomatous Disord. 2007;27(1):89–102.

Publication types