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Chest pain with normal coronary arteries: a comparative study of psychiatric and social morbidity

  • Christopher Bass (a1) and Clyde Wade (a1)
Synopsis

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.

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Corresponding author
1 Address for correspondence: Dr Christopher Bass Academic Department of Psychological Medicine, King's College Hospital, Denmark Hill, London SE5 9RS.
References
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Abrams, H. L. & Adams, D. F. (1969). The coronary anteriogram. New England Journal of Medicine 281, 12761285, 1336–1342.
Alban, Davies H., Jones, D. B. & Rhodes, J. (1982). ‘Esophageal angina’ as the cause of chest pain. Journal of the American Medical Association 248, 22742278.
Bass, C., Cawley, R., Wade, C., Jackson, G., Gardner, W. N., Hutchison, D. C. S. & Ryan, K. C. (1983). Unexplained breathlessness and psychiatric morbidity in patients with normal and abnormal coronary arteries. Lancet i, 605609.
Bond, M. R. (1971). The relation of pain to the Eysenck Personality Inventory, Cornell Medical Index and Whitley Index of Hypochon-driasis. British Journal of Psychiatry 119, 671678.
Bruschke, A. V., Proudfit, W. L. & Sones, F. M. (1973). Clinical course of patients with normal and slightly or moderately abnormal coronary arteriograms. A follow-up study of 500 patients. Circulation 47, 936945.
Caston, J., Cooper, L. & Paley, H. W. (1970). Psychological comparison of patients with cardiac neurotic chest pain and angina pectoris. Psychosomatics 11, 543550.
Clare, A. W. & Cairns, V. E. (1978). Design, development and use of a standardized interview to assess social maladjustment and dysfunction in community studies. Psychological Medicine 8, 589604.
Cohen, M. E. & White, P. D. (1951). Life situations, emotions and neurocirculatory asthenia (anxiety neurosis, neurasthenia, effort syndrome). Psychosomatic Medicine 13, 335357.
Cooper, B. (1972). Clinical and social aspects of chronic neurosis. Proceedings of the Royal Society of Medicine 65, 509512.
Da, Costa J. M. (1871). On irritable heart; a clinical study of a form of functional cardiac disorder and its consequences. American Journal of the Medical Sciences 61, 1752.
Davies, B. (1964). Psychiatric illness at general hospital clinics. Postgraduate Medical Journal 40, 1518.
Day, L. J. & Sowton, E. (1976). Clinical features and follow-up of patients with angina and normal coronary arteries. Lancet ii, 334337.
Eysenck, H. J. & Eysenck, S. B. (1975). Manual of the Eysenck Personality Questionnaire. Hodder and Stoughton Educational: London.
Eysenck, S. B. (1961). Personality and pain assessment in childbirth of married and unmarried mothers. Journal of Mental Science 107, 417430.
Garssen, B., van Weenendaal, W. & Bloemink, R. (1984). Agoraphobia and the hyperventilation syndrome. Behaviour Research and Therapy. (In the press.)
Goldberg, D. P. (1970). A psychiatric study of patients with diseases of the small intestine. Gut 11, 459465.
Goldberg, D. P., Cooper, B., Eastwood, M. R., Kedward, H. B. & Shepherd, M. (1970). A standardised psychiatric interview for use in community surveys. British Journal of Preventive and Social Medicine 24, 1823.
Isner, J. M., Salem, D. N., Banas, J. S. & Levine, H. J. (1981). Long-term clinical course of patients with normal coronary arteriography: follow-up study of 121 patients with normal or near-normal coronary arteriograms. American Heart Journal 102, 645653.
Judkins, M. P. (1967). Selective coronary arteriography: I. A percutaneous transfemoral technic. Radiology 89, 815824.
Kemp, H. G., Elliot, W. C. & Gorlin, R. (1967). The anginal syndrome with normal coronary arteriography. Transactions of the Association of American Physicians 80, 5970.
Kemp, H. G., Vokonas, P. S., Cohn, P. F. & Gorlin, R. (1973). The anginal syndrome associated with normal coronary arteriograms. Report of a six year experience. American Journal of Medicine 54, 735742.
Lancet (1979). Psychiatric illness among medical patients; i, 478479.
Lancet (1980). Chest pain with normal coronary arteries; i, 130.
Lavey, E. B. & Winkle, R. A. (1979). Continuing disability of patients with chest pain and normal coronary arteriograms. Journal of Chronic Disease 32, 191196.
Lewis, T. (1918). The Soldiers Heart and the Effort Syndrome. Shaw and Sons: London.
Likoff, W., Segal, B. L. & Kasparian, H. (1967). Paradox of normal selective coronary arteriograms in patients considered to have unmistakeable coronary heart disease. New England Journal of Medicine 276, 10631066.
Lipowski, Z. J. (1980). Cardiovascular disorders. In Comprehensive Textbook of Psychiatry (ed. Kaplan, H. I., Freedman, A. M. and Sadock, B. J.), pp. 18911907. Williams and Wilkins: Baltimore.
Macdonald, A. J. & Bouchier, I. A. D. (1980). Non-organic gastrointestinal illness: a medical and psychiatric study. British Journal of Psychiatry 136, 276283.
Marks, I. & Lader, M. (1973). Anxiety states (anxiety neurosis): a review. Journal of Nervous and Mental Disease 156, 318.
Master, A. M. (1964). The spectrum of anginal and non-cardiac chest pain. Journal of the American Medical Association 187, 894899.
Mayou, R. (1973). The patient with angina: symptoms and disability. Postgraduate Medical Journal 49, 250254.
Ockene, I. S., Shay, M. J., Alpert, J. S., Weiner, B. H. & Dalen, J. E. (1980). Unexplained chest pain in patients with normal coronary arteriograms. A follow-up study of functional status. New England Journal of Medicine 303, 12491252.
Oppenheimer, B. S. & Rothschild, M. A. (1918). The psychoneurotic factor in the ‘irritable heart of soldiers’. British Medical Journal ii, 2931.
Osler, W. (1892). The Principles and Practice of Medicine. J. Pentland Young: Edinburgh.
Selzer, A. (1977). Cardiac ischaemic pain in patients with normal coronary arteriograms. American Journal of Medicine 63, 661665.
Skerritt, P. W. (1983). Anxiety and the heart–a historical review. Psychological Medicine 13, 1725.
Waxler, E. B., Kimbiris, D. & Dreifus, L. S. (1971). The fate of women with normal coronary arteriograms and chest pain resembling angina pectoris. American Journal of Cardiology 28, 2532.
Wittkower, E., Rodger, T. F. & Macbeth Wilson, A. T. (1941). Effort syndrome. Lancet i, 531535.
Wood, P. (1941). Da Costa's syndrome (or effort syndrome). British Medical Journal i, 767772, 805–811, 845–851.
Wooley, C. F. (1976). Where are the diseases of yesteryear? Circulation 53, 749751.
World Health Organization (1978). Mental Disorders: Glossary and Guide to their Classification in Accordance with the Ninth Revision of the International Classification of Disease. WHO: Geneva.
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Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
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