Panic disorder and incident coronary heart disease: a systematic review and meta-analysis protocol

Table 1 List of possible symptoms experienced during a panic attack

Number	Panic disorder symptom
1	Palpitations, pounding heart, or accelerated heart rate
2	Sweating
3	Trembling or shaking
4	Sensations of shortness of breath or smothering
5	Feelings of choking
6	Chest pain or discomfort
7	Nausea or abdominal distress
8	Feeling dizzy, unsteady, light-headed, or faint
9	Chills or heat sensations
10	Paresthesias (numbness or tingling sensations)
11	Derealization (feelings of unreality) or depersonalization (being detached from oneself)
12	Fear of losing control or ‘going crazy’
13	Fear of dying

Panic disorder/panic attack symptoms adapted from the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition [6].
Additional qualifiers:
A. A panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four (or more) of the above symptoms occur.
B. At least one of the attacks has been followed by 1 month (or more) of one or both of the following:
1. Persistent concern or worry about additional panic attacks or their consequences (for example, losing control, having a heart attack, ‘going crazy’).
2. A significant maladaptive change in behavior related to the attacks (for example, behaviors designed to avoid having panic attacks, such as avoidance of exercise or unfamiliar situations).
A. The disturbance is not attributable to the physiological effects of a substance (for example, a drug of abuse, a medication) or another medical condition (for example, hyperthyroidism, cardiopulmonary disorders).
B. The disturbance is not better explained by another mental disorder (for example, the panic attacks do not occur only in response to feared social situations, as in social anxiety disorder; in response to circumscribed phobic objects or situations, as in specific phobia; in response to obsessions, as in obsessive-compulsive disorder; in response to reminders of traumatic events, as in posttraumatic stress disorder; or in response to separation from attachment figures, as in separation anxiety disorder).

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