Claustrophobia, Panic Attacks and Caffeine Intolerance may NOT be associated with Diastolic Dysfunction: A Pre-Echocardiogram Questionnaire-Based Pilot Study

Background: Diastolic heart dysfunction may explain the enigmatic pathophysiology of panic attacks and re la ted d i so rde rs l i ke c laus t rophob ia , subjective/objective intolerance of heated enclosed environments and caffeine intolerance/allergy that can be sometimes indistinguishable from panic attacks symptomatically. Objectives: To investigate whether clinical history of panic attacks-claustrophobia-caffeine intolerance is more common in patients with undiagnosed diastolic dysfunction who present for their outpatient echocardiogram tests. Materials and Methods: Consenting adult outpatients who presented for their scheduled outpatient echocardiogram or stress echocardiogram at our University Hospital based Echocardiography Laboratory were asked to complete a questionnaire related to the clinical history of panic attacks, claustrophobia and caffeine intolerance. Spearman Rank Correlation and Partial Correlation Coefficients were used to correlate echocardiographic diastolic function grades with claustrophobia, panic attacks and caffeine intolerance based extracted (CP/CI/CPCI ) scores. Results: Due to very small (n=40) pilot results (despite planned large-scale study at outset), we were only able to infer that: (a) there was only 75% inter-rater concordance in regards to diagnosing diastolic heart function on echocardiogram; (b) patients with diastolic heart dysfunction were significantly older; (c) 75% patients in our study pool were females; (d) diastolic heart dysfunction was prevalent in 45% patients; (e) there was very little (if any) clinical significance of CP/CI/CPCI scores in regards to predicting diastolic dysfunction grading; and (f) claustrophobia-panic attacks vs. caffeine-intolerance/allergy did not co-exist as co-morbidities in our set of patients. Conclusion: Per our pre-echocardiogram questionnaire-based pilot study, claustrophobia, panic attacks and caffeine intolerance may NOT be associated with diastolic dysfunction.