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June 6, 1986

Panic Attacks and Idiopathic Cardiomyopathy

Author Affiliations

Columbia-Presbyterian Medical Center New York

JAMA. 1986;255(21):2898. doi:10.1001/jama.1986.03370210066018

To the Editor.—  Idiopathic cardiomyopathy is a syndrome of progressive myocardial dysfunction, often associated with recurrent myocarditis.1 Routine psychiatric evaluation of cardiac transplant candidates suggests that many patients with end-stage idiopathic cardiomyopathy have panic disorder. Panic disorder is a syndrome of recurrent episodes of abrupt-onset anxiety, associated with certain symptoms of autonomic arousal. Panic anxiety is readily treated by alprazolam, although not by other benzodiazepines. Preliminary clinical observation of these cardiac transplant candidates suggests that their panic attacks are distinct from, and may precede, initial cardiac symptoms. Some patients also report a history similar to William Harvey's 1649 description of a man overwhelmed with suppressed rage who died with a massively enlarged heart.2

Report of a Case.—  A 28-year-old man described himself as a former hotheaded rowdy with a history of binge drinking. He changed his behavior when he married six years ago. At about that time, he began