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Paniekstoornis, hyperventilatie, cardiale afwijkingen en cogntieve misinterpretaties

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Samenvatting

Hartkloppingen komen vaak voor bij patiënten met paniekstoornis en agorafobie. In het algemeen wordt hyperventilatie gezien als een stressreactie die o.a. hartkloppingen tot gevolg heeft, maar op zichzelf ongevaarlijk is. In cognitieve therapie volgens Clark en Salkovskis wordt angst voor hartkloppingen beschouwd als een cognitieve misinterpretatie die de paniekstoornis in stand houdt (Clark & Salkovskis, 1987). Echter, de mortaliteit aan cardiovasculaire aandoeningen is bij paniekstoornis verhoogd, met name bij mannen ouder dan veertig jaar. Bovendien zijn er bij patiënten met de variant angina volgens Prinzmetal dodelijke complicaties beschreven van hyperventilatie. De notie van de cognitieve misinterpretatie lijkt bij deze patiënten dus niet te gelden. Hoeveel patiënten er zowel aan paniekstoornis als aan deze hartkwaal lijden is niet bekend. Duidelijk is echter dat deze groep niet aan hyperventilatieprovocatie blootgesteld zou moeten worden. De auteurs adviseren bij patiënten met paniekstoornis en klachten van pijn op de borst, die ouder zijn dan veertig jaar, een ECG onder hyperventilatie te verrichten.

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    Hilmar Backer

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  1. Hilmar Backer
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  2. Richard van Dyck
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Abstract

Panic disorder, hyperventilation, cardiovascular disease and cognitive misinterpretations. Palpitations is a frequently heard complaint in patients with panic disorder and agoraphobia. Hyperventilation is generally seen as a stress reaction leading to (a.o.) palpitations, but is in itself harmless. Cognitive behavioural therapy according to Clark and Salkovskis regards fear of palpitations as a cognitive misinterpretation that maintains the panic disorder (Clark and Salkovskis, 1987). However, mortality due to cardiovascular disease is increased in panic disorder, especially in men older than 40 years. Moreover, deadly complications of hyperventilation have been reported in patients with Prinzmetal’s variant angina. The notion of the cognitive misinterpretation does not seem to hold for these patients. How many patients suffer from both panic disorder and agoraphobia, and variant angina, is unknown. It is clear however, that these patients should not be submitted to forced hyperventilation. The authors advise to do a forced hyperventilation test under electrocardiographical control, in patients older than 40 years with panic disorder and chest pain.

H. S. Backer is arts-assistent psychiatrie (VU Amsterdam); Dr. R. van Dyck is hoogleraar psychiatrie aan de VU in Amsterdam. Correspondentieadres: P.C.A. Valeriuskliniek, Valeriusplein 9 1075 BG Amsterdam.

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Backer, H., Dyck, R. Paniekstoornis, hyperventilatie, cardiale afwijkingen en cogntieve misinterpretaties. DITH 13, 87–90 (1993). https://doi.org/10.1007/BF03060030

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