[Chest pain and anxiety-panic disorders in a primary care clinic]

Chest pain is one of the most common complaints in primary care clinics. About 10-30% of patients with chest pain diagnosed as suffering from angina pectoris have normal coronary angiograms. Some of them suffer from psychiatric disorders. We present a 47-year-old man with several risk factors for ischemic heart disease: smoker in the past, obesity, hyperlipidemia and family history of coronary disease. He had complaints typical of anginal syndrome and normal coronary arteriograms. After 1.5 years of unsuccessful medical treatment, he was referred to the psychiatrist in the primary care clinic who diagnosed anxiety and panic disorders with somatization. All cardiac drugs were stopped and psychopharmacological treatment and psychotherapy were started immediately. Within a month he was almost free of symptoms and was treated successfully for a year. Treatment was then stopped and he has remained symptom-free for the past 4 years. We conclude that in such atypical somatic cases, only the collaboration of general practitioner and psychiatrist will lead to quick diagnosis and successful treatment.