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Chest pain and angiographically normal coronary arteries. Implications for treatment
V Mukerji1, B D Beitman, M A Alpert
1Department of Medicine, University of South Alabama College of Medicine, Mobile.
Insights
Many patients with chest pain have normal coronary arteries but suffer disabling symptoms. Panic disorder is a common, treatable cause, significantly impacting quality of life.
Area of Science:
- Cardiology
- Psychiatry
Background:
- Coronary arteriography reveals normal coronary arteries in 20-30% of patients evaluated for chest pain.
- These patients often experience persistent, disabling chest pain despite a good survival rate.
Purpose of the Study:
- To identify the most common underlying conditions in patients with chest pain and normal coronary arteries.
- To highlight the impact of panic disorder on this patient group.
Main Methods:
- Review of patients undergoing coronary arteriography for chest pain evaluation.
- Differential diagnosis including microvascular angina, esophageal dysfunction, fibromyalgia, and panic disorder.
Main Results:
- Panic disorder is diagnosed in at least one-third of patients with chest pain and normal coronary arteries.
- Panic disorder can co-exist with other conditions like microvascular angina.
Conclusions:
- Accurate diagnosis and treatment of panic disorder are crucial for managing psychosocial morbidity in patients with chest pain and normal coronary arteries.
- Addressing panic disorder can improve the quality of life for affected individuals.
Abstract:
Approximately 20% to 30% of patients who undergo coronary arteriography for the evaluation of chest pain are found to have normal coronary arteries. These patients have a survival rate comparable to that of the normal population, yet they continue to complain of symptoms on extended follow-up, and about half of this group are disabled on account of chest pain. Once other clinically obvious disorders have been ruled out, common diagnostic considerations include microvascular angina, esophageal dysfunction, and perhaps fibromyalgia. Panic disorder, however, is the most common condition affecting these patients and can be diagnosed in at least one third of the group, with or without the presence of the other conditions mentioned. Appropriate diagnosis and treatment can reduce the psychosocial morbidity so frequently seen in these patients.