Chest pain with normal coronary arteries: a comparative study of psychiatric and social morbidity

Abstract

SynopsisNinety-nine patients with chest pain and a presumptive diagnosis of coronary heart disease were assessed blindly within 24 hours of angiography, using standardized psychiatric and social interviews and a personality inventory. Thirty-one patients had normal coronary arteries (NCA), 15 had slight disease and 53 had significant coronary obstruction. Twenty-eight (61%) of the 46 patients with insignificant disease and 12 (23%) of the 53 with significant obstruction had psychiatric morbidity.Associations between the overall severity of psychiatric morbidity and measures of social maladjustment were strongest in the patients with normal coronary arteries. The 26 men with insignificant coronary artery disease had higher scores of neuroticism and extraversion than the 41 with important coronary occlusions. No differences were observed when the same comparisons were made for the women.The findings indicate that approximately two thirds of patients with normal and near-normal coronary arteries have predominantly psychiatric rather than cardiac disorders: the symptoms in these patients are more likely to represent the somatic manifestations of anxiety and overbreathing than the consequences of underlying cardiac disease. Physicians should be aware of the ways in which neurotic illness may present with symptoms mimicking cardiac disease, especially when cardiovascular symptoms are accompanied by phobic symptoms and unexplained shortness of breath.

Psychosocial Modulators of Angina Response to Myocardial Ischemia

“…11 Much of this research, however, has focused on the role of psychosocial factors in chest pain patients with normal coronary arteries. [12][13][14] We hypothesized that psychosocial factors may also modulate angina in patients with demonstrable myocardial ischemia. We therefore investigated the association of patient factors, including psychosocial factors, with the frequency of angina in patients with inducible ischemia on single-photon emission computed tomography (SPECT) stress perfusion imaging after adjusting for the degree of ischemia so that differences in angina frequency would be independent of the physiological impact of patients' coronary obstructions.…”

Does the Association Between Mitral Valve Prolapse and Panic Disorder Really Exist?

“…34,[51][52][53][54][55][56][57][58][59][60][61][62][63][64] This wide variability can be explained by different factors. As an example, not all studies used homogeneous samples; this was the case for the study by Kathol et al, 51 who included patients with other anxiety disorders, and for the studies by Pariser et al 12 and Carney et al, 45 who included patients with major depression and panic attacks.…”

Dor torácica em pacientes com cinecoronariografia normal (síndrome X): novos conceitos

“…De fato, deve ser o mecanismo causal da dor em considerável parcela de casos. Vários estudos confirmam incidência muito elevada de distúrbios psíquicos nos pacientes com síndrome X, isoladamente, ou quando comparados com pacientes com doença arterial coronariana [48][49][50][51][52] . Analisando o prognóstico psicossocial de pacientes com síndrome X, em comparação com portadores de doença arterial coronariana, Juelsgaard et al verificaram que os primeiros, após seguimento médio de sete anos, tiveram índices muito maiores de piora da dor ou dor inalterada, diminuição da atividade física, divórcio ou separação conjugal e abandono de trabalho 53 .…”