Epidemiological Characteristics of Patients With Supraventricular Tachycardias Who Were Inappropriately Diagnosed With Panic Attacks: Experience From a Large Saudi Tertiary Care Center.

Abstract

Objectives: Supraventricular tachycardia (SVT) is a significant cause of morbidity in patients visiting cardiology clinics with a chief complaint of palpitations and notable signs of distress worldwide. SVTs and panic attacks have overlapping clinical presentations, beginning with rapid palpitations of the heart that start abruptly and can be accompanied by shortness of breath, chest pain or discomfort, and a feeling of lightheadedness. The diagnosis could be straightforward if an ECG is recorded precisely during the attack. The chances of misdiagnosing patients with panic attacks increase because of the self-terminating nature of SVTs. Given the diagnostic dilemma caused by these conditions and lack of corresponding literature, we aimed to determine the true incidence of patients who were misdiagnosed with anxiety disorder and were later appropriately diagnosed with SVT in a large tertiary care center.

Methods: We retrospectively reviewed the records of 105 patients, both male and female aged ≥18 years, from King Abdulaziz University Hospital Jeddah, Saudi Arabia. Patients who were diagnosed with SVT between January 2015 and January 2023 and had data regarding SVT subtype, date of SVT diagnosis, and comorbidities were included. Patients with a confirmed diagnosis of a psychiatric condition were excluded. Ninety patients were contacted to participate in a prospective phone survey involving a subjective assessment of SVT symptomatology. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, panic disorder criteria under the classification of anxiety disorders were applied.

Results: Forty-seven patients responded, while 43 were lost to contact for reasons, such as out-of-service or switched off phones. In the final group, 20 patients (42.6%) were misdiagnosed with anxiety/panic attacks before being correctly diagnosed with SVT. The most prominent subtype was AVNRT (57.4%). The clinical presentations of both panic attacks and arrhythmia coincided; differentiation was performed based on the ECG results during the episode and appropriate further workup. SVT can be easily misdiagnosed as anxiety due to several factors, including lack of ECG and overlapping symptomatology.

Conclusions: Further research is needed to better assess the relationship between the overlapping clinical presentations of SVTs and panic attacks. Overall, physician awareness must be increased to avoid misdiagnosis, which can delay appropriate management of the underlying medical arrhythmia.