Dynamics of anxiety in women undergoing coronary angiography

Anxiety is a common and serious problem in ischaemic heart disease. Anxiety-associated somatisation disorders may imitate symptoms of coronary artery disease or coexist with ischaemic heart disease. Despite multiple visits to various specialists, patients with somatisation are frequently misdiagnosed and therefore mistreated. Identification of patients with anxiety disorders among patients complaining of chest pain is a prerequisite for appropriate management. By its nature, coronary angiography is a diagnostic test that can give rise to anxiety. However, dynamics of anxiety in this setting may be variable depending on coexisting mental disorders.

The purpose of this study was to determine whether the presence of significant atherosclerotic lesions in coronary arteries affects anxiety level changes following coronary angiography.

A group of 90 female patients who underwent coronary angiography was divided into two groups: the first one included 48 patients without significant coronary stenoses, and the other one included 42 patients with confirmed significant atherosclerotic lesions. Dynamics of anxiety level changes from the hospital admission, through the post-examination period, until 6 to 9 months after coronary angiography was evaluated with three-time measurement of anxiety using the Spielberger's State-Trait Anxiety Inventory. In addition, intensity of anxiety as a trait was measured twice (at the first and the third examination).

The highest intensity of anxiety as a state was noted in both groups at the first measurement. A significant reduction in anxiety was observed at the second measurement, more pronounced in the group without significant coronary lesions. At the third measurement, women with confirmed significant coronary lesions showed the lowest level of anxiety, while the level of anxiety increased compared to the second measurement in the group of patients without significant coronary lesions. At the third measurement, women without significant coronary lesions showed a significantly higher level of anxiety compared to the group with significant coronary lesions. Intensity of anxiety as a trait was significantly lower at the final measurement in the group of patients with confirmed significant coronary stenoses.

In women demonstrating no significant atherosclerotic lesions in coronary angiography, anxiety does not resolve permanently but reappears after several months. In this group, is seems justified to consider a diagnosis of an anxiety disorder in the form of a somatoform disorder. Those patients should be offered psychiatric therapy.