Symptoms of Anxiety and Depression Are Correlates of Angina Pectoris by Recent History and an Ischemia-Positive Treadmill Test in Patients with Documented Coronary Artery Disease in the Pimi Study

Abstract

Objective. We tested the association of specific psychological characteristics in patients having stable coronary disease with the reporting of anginal symptoms during daily activities, and positive exercise testing. Methods. One hundred and ninety-six patients with documented CAD enrolled in the Psychophysiological Investigations of Myocardial Ischemia (PIMI) Study completed an anginal history questionnaire and a battery of psychometric tests. They also underwent standardized exercise treadmill tests. Results. Patients with a recent history of angina were more likely to be female, and had higher Beck Depression (P = .002), State Anxiety (P = .001), Trait Anxiety (P = .03), Harm Avoidance (P = .04) and Muscle Tension (P = .004) scores than patients who had no recent history of angina. Along with several treadmill variables indicating more severe disease state and reduced exercise tolerance, patients who developed angina on a positive treadmill test also displayed higher scores on the Beck Depression Inventory (P = .003) and State Anxiety (P = .004) scales. Conclusions. Several psychological characteristics, and most notably anxiety and depression, are strong correlates of recent angina and angina in the presence of ischemia provoked by treadmill testing.

Angina and mental stress-induced myocardial ischemia

“…In the Psychophysiological Investigations of Myocardial Ischemia (PIMI) study, exercise stress ischemia was not associated with history of daily life angina, while chest pain during exercise stress testing was associated with angina in daily life [27]. Furthermore, similar to our study, there was a strong relationship between daily life angina and depressive and anxiety symptoms [28]. Patients with mental stress ischemia more often had silent ischemia during daily life than patients without mental stress ischemia, while ischemia with exercise stress was not related to daily life ischemia [4].…”

Psychological and Physiological Predictors of Angina During Exercise-Induced Ischemia in Patients With Coronary Artery Disease

“…Depressive symptoms are related to cardiac symptoms (25). Using data from the NHLBI PIMI study, the present investigators have demonstrated a relationship between anxiety and depressive symptoms and both history of angina and anginal pain latency (26). Depressed patients are more likely to develop post-MI angina (22), and depression not only plays a role in the development of CAD in general, but of anginal pain in particular (22,27).…”

Anksioznost in koronarna bolezen srca

“…Z jakostjo angine pektoris se okrepita tako anksioznost kot depresivnost. Zato se poslabša kakovost ži-vljenja in zmanjša telesna zmogljivost pri bolnikih, ki so preboleli miokardni infarkt ali imajo stabilno koronarno bolezen (15)(16)(17). Ena od hipotez o nastanku angine pektoris v vsakdanjem življenju je koronarna mikrovaskularna disfunkcija, na katero naj bi vplivali različni psihosocialni in nevrobiološki mehanizmi, med drugim tudi subjektivno doživlja-nje stresa in fiziološke spremembe v nevroendokrinem in žilnem okolju (14,17).…”