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Unexplained breathlessness and psychiatric morbidity in patients with normal and abnormal coronary arteries
Insights
Chest pain patients often have psychiatric issues and unexplained breathing disorder (UBD) when coronary arteries are clear. However, these conditions can coexist with coronary artery disease, complicating diagnosis.
Area of Science:
- Cardiology
- Psychiatry
- Pulmonology
Background:
- Chest pain is a common symptom with diverse etiologies.
- Distinguishing cardiac from non-cardiac causes, including psychiatric and respiratory disorders, is crucial for accurate diagnosis and treatment.
Purpose of the Study:
- To investigate the prevalence of psychiatric morbidity and unexplained breathing disorder (UBD) in patients with chest pain.
- To explore the relationship between these conditions and the severity of coronary artery disease.
Main Methods:
- Coronary arteriography was performed on 99 patients presenting with chest pain.
- Psychiatric morbidity was assessed using standard interviews.
- Unexplained breathing disorder (UBD) was identified based on clinical symptoms and signs; end-tidal pCO2 levels were measured.
Main Results:
- Significant coronary obstruction was found in 53 patients, while 46 had insignificant disease or normal arteries.
- Psychiatric morbidity was higher in patients with insignificant coronary disease (61%) compared to those with significant obstruction (23%).
- UBD was more prevalent in patients without significant coronary disease (65%) and was associated with psychiatric morbidity in this group. End-tidal pCO2 below 30 mm Hg was suggestive of UBD.
Conclusions:
- In patients with chest pain and no significant coronary disease, psychiatric morbidity and UBD are frequently observed and associated.
- Coronary artery disease and UBD can coexist, presenting diagnostic challenges.
- Further investigation is needed to understand the complex interplay between cardiac, psychiatric, and respiratory factors in chest pain presentation.
Abstract:
Of 99 patients with chest pain undergoing coronary arteriography, 31 had normal coronary arteries, 15 slight disease, and 53 significant coronary obstruction. 28 (61%) of the 46 with haemodynamically insignificant disease and 12 (23%) of the 53 with significant obstruction had psychiatric morbidity, assessed by standard interview. 37 patients had several respiratory symptoms and signs not attributable to organic disease, designated unexplained breathing disorder (UBD). UBD was found in 65% of the patients without and 13% of those with significant coronary disease; it was associated with psychiatric morbidity in the former but not in the latter group. Spirographic measurements of tidal volume and frequency were not helpful in detecting UBD but an end-tidal pCO2 below 30 mm Hg was highly suggestive. In the absence of significant coronary disease the associations of chest pain with psychiatric morbidity and UBD are striking. However, coronary disease and UBD are not mutually exclusive, and diagnostic difficulties can occur when they coexist.