Mental Stress-Induced Myocardial Ischemia Related to Generalized Anxiety Disorder in a Patient With Acute Coronary Syndrome and Normal Coronary Arteries

Clin Nucl Med. 2016 Nov;41(11):e487-e490. doi: 10.1097/RLU.0000000000001348.

Abstract

Mental stress-induced myocardial ischemia (MSIMI) has been described in patients with acute coronary syndrome (ACS). We reported the case of a patient admitted with ACS and MSIMI related to generalized anxiety disorder (GAD). Myocardial perfusion imaging (MPI) after exercise stress and computed tomography coronary angiography showed normal results. In contrast, MPI with mental stress documented MSIMI. He began to improve 7 days after starting escitalopram and remained without angina at 1-year follow-up. These data suggest the applicability of mental stress radionuclide imaging for the detection of MSIMI in patients with ACS and GAD, even in normal coronary arteries.

Publication types

  • Case Reports

MeSH terms

  • Acute Coronary Syndrome / diagnostic imaging*
  • Acute Coronary Syndrome / etiology
  • Acute Coronary Syndrome / psychology
  • Anxiety Disorders / complications
  • Anxiety Disorders / drug therapy
  • Anxiety Disorders / psychology*
  • Citalopram / therapeutic use
  • Computed Tomography Angiography
  • Coronary Angiography
  • Coronary Vessels / diagnostic imaging*
  • Exercise Test
  • Humans
  • Male
  • Myocardial Ischemia / diagnostic imaging*
  • Myocardial Ischemia / etiology
  • Myocardial Ischemia / psychology
  • Myocardial Perfusion Imaging
  • Selective Serotonin Reuptake Inhibitors / therapeutic use
  • Stress, Psychological / complications
  • Stress, Psychological / drug therapy
  • Stress, Psychological / psychology*
  • Young Adult

Substances

  • Serotonin Uptake Inhibitors
  • Citalopram