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Chest pain with normal coronary arteries: a comparative study of psychiatric and social morbidity
Insights
Many patients with chest pain and normal coronary arteries have psychiatric disorders, not heart disease. These symptoms may stem from anxiety and overbreathing, mimicking cardiac issues.
Area of Science:
- Cardiology
- Psychiatry
- Psychosomatic Medicine
Background:
- Chest pain is a common symptom with a presumptive diagnosis of coronary heart disease.
- Patients with chest pain undergo angiography to assess coronary artery status.
- Psychiatric and social factors may influence the presentation of chest pain.
Purpose of the Study:
- To investigate the prevalence of psychiatric morbidity in patients with chest pain and varying degrees of coronary artery disease.
- To explore the association between psychiatric morbidity, social maladjustment, and coronary artery disease severity.
- To differentiate between cardiac and psychiatric causes of chest pain in patients with normal or near-normal coronary arteries.
Main Methods:
- Ninety-nine patients with chest pain were blindly assessed within 24 hours of angiography.
- Standardized psychiatric and social interviews and a personality inventory were utilized.
- Patients were categorized based on coronary artery findings: normal (NCA), slight, and significant obstruction.
Main Results:
- Psychiatric morbidity was present in 61% of patients with insignificant coronary artery disease and 23% with significant obstruction.
- Strongest associations between psychiatric morbidity and social maladjustment were found in patients with normal coronary arteries.
- Men with insignificant coronary artery disease showed higher neuroticism and extraversion scores than those with significant occlusions; no such difference was observed in women.
Conclusions:
- Approximately two-thirds of patients with normal or near-normal coronary arteries exhibit predominantly psychiatric disorders.
- Symptoms in these patients are more likely somatic manifestations of anxiety and overbreathing than cardiac disease.
- Physicians should consider neurotic illness presenting as cardiac symptoms, especially with phobic symptoms and unexplained shortness of breath.
Abstract:
Ninety-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.