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A review of the medical literature reveals that panic has been associated with cardiovascular dysfunction for well over a century. More recently, investigators have
noted that the symptoms of mitral valve prolapse and of panic disorder are nearly identical; but they have not yet clarified the causal relationship of these two disorders.
The differential diagnosis of anxiety includes withdrawal states, intoxication, schizophrenic and depressive disorders, endocrine disorders, complex partial seizures, as well as mitral valve prolapse and other cardiovascular disorders. A diagnosis of mitral valve prolapse dictates screening for panic disorder. Similarly, a diagnosis of panic disorder mandates evaluation and treatment for the complications of mitral valve prolapse.
A multimodal therapeutic approach to panic disorder is most effective. The biological core, which is manifested by eruptions of anxiety in specific feared situations, is controlled with pharmacotherapy. Phobic avoidance is best mitigated with behavior therapy. The psychosocial components of this disorder are resolved through psychotherapy.