Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
권호 표지
DOI QR코드

DOI QR Code

Psychiatric Characteristics of the Cardiac Outpatients with Chest Pain

  • Lee, Jea-Geun (Division of Cardiology, Department of Internal Medicine, School of Medicine, Jeju National University) ;
  • Choi, Joon Hyouk (Division of Cardiology, Department of Internal Medicine, School of Medicine, Jeju National University) ;
  • Kim, Song-Yi (Division of Cardiology, Department of Internal Medicine, School of Medicine, Jeju National University) ;
  • Kim, Ki-Seok (Division of Cardiology, Department of Internal Medicine, School of Medicine, Jeju National University) ;
  • Joo, Seung-Jae (Division of Cardiology, Department of Internal Medicine, School of Medicine, Jeju National University)
  • Received : 2015.03.03
  • Accepted : 2015.08.10
  • Published : 2016.03.30
⟨ Previous Next ⟩

Abstract

Background and Objectives: A cardiologist's evaluation of psychiatric symptoms in patients with chest pain is rare. This study aimed to determine the psychiatric characteristics of patients with and without coronary artery disease (CAD) and explore their relationship with the intensity of chest pain. Subjects and Methods: Out of 139 consecutive patients referred to the cardiology outpatient department, 31 with atypical chest pain (heartburn, acid regurgitation, dyspnea, and palpitation) were excluded and 108 were enrolled for the present study. The enrolled patients underwent complete numerical rating scale of chest pain and the symptom checklist for minor psychiatric disorders at the time of first outpatient visit. The non-CAD group consisted of patients with a normal stress test, coronary computed tomography angiogram, or coronary angiogram, and the CAD group included those with an abnormal coronary angiogram. Results: Nineteen patients (17.6%) were diagnosed with CAD. No differences in the psychiatric characteristics were observed between the groups. "Feeling tense", "self-reproach", and "trouble falling asleep" were more frequently observed in the non-CAD (p=0.007; p=0.046; p=0.044) group. In a multiple linear regression analysis with a stepwise selection, somatization without chest pain in the non-CAD group and hypochondriasis in the CAD group were linearly associated with the intensity of chest pain (${\beta}=0.108$, $R^2=0.092$, p=0.004; ${\beta}=-0.525$, $R^2=0.290$, p=0.010). Conclusion: No differences in psychiatric characteristics were observed between the groups. The intensity of chest pain was linearly associated with somatization without chest pain in the non-CAD group and inversely linearly associated with hypochondriasis in the CAD group.

Keywords

Acknowledgement

Supported by : Jeju National University Hospital

References

  1. Papanicolaou MN, Califf RM, Hlatky MA, et al. Prognostic implications of angiographically normal and insignificantly narrowed coronary arteries. Am J Cardiol 1986;58:1181-7. https://doi.org/10.1016/0002-9149(86)90378-4
  2. Hoffmann U, Nagurney JT, Moselewski F, et al. Coronary multidetector computed tomography in the assessment of patients with acute chest pain. Circulation 2006;114:2251-60. https://doi.org/10.1161/CIRCULATIONAHA.106.634808
  3. Kroenke K, Mangelsdorff AD. Common symptoms in ambulatory care: incidence, evaluation, therapy, and outcome. Am J Med 1989;86:262-6. https://doi.org/10.1016/0002-9343(89)90293-3
  4. Mayou R, Bryant B, Forfar C, Clark D. Non-cardiac chest pain and benign palpitations in the cardiac clinic. Br Heart J 1994;72:548-53. https://doi.org/10.1136/hrt.72.6.548
  5. Channer KS, Papouchado M, James MA, Rees JR. Anxiety and depression in patients with chest pain referred for exercise testing. Lancet 1985;2:820-3.
  6. Cormier LE, Katon W, Russo J, Hollifield M, Hall ML, Vitaliano PP. Chest pain with negative cardiac diagnostic studies. Relationship to psychiatric illness. J Nerv Ment Dis 1988;176:351-8. https://doi.org/10.1097/00005053-198806000-00004
  7. Dammen T, Arnesen H, Ekeberg O, Friis S. Psychological factors, pain attribution and medical morbidity in chest-pain patients with and without coronary artery disease. Gen Hosp Psychiatry 2004;26:463-9. https://doi.org/10.1016/j.genhosppsych.2004.08.004
  8. Zachariae R, Melchiorsen H, Frobert O, Bjerring P, Bagger JP. Experimental pain and psychologic status of patients with chest pain with normal coronary arteries or ischemic heart disease. Am Heart J 2001;142:63-71. https://doi.org/10.1067/mhj.2001.115794
  9. Tennant C, Mihailidou A, Scott A, et al. Psychological symptom profiles in patients with chest pain. J Psychosom Res 1994;38:365-71. https://doi.org/10.1016/0022-3999(94)90041-8
  10. Kisely SR. The relationship between admission to hospital with chest pain and psychiatric disorder. Aust N Z J Psychiatry 1998;32:172-9. https://doi.org/10.3109/00048679809062726
  11. Mayou RA, Bryant BM, Sanders D, Bass C, Klimes I, Forfar C. A controlled trial of cognitive behavioural therapy for non-cardiac chest pain. Psychol Med 1997;27:1021-31. https://doi.org/10.1017/S0033291797005254
  12. Cannon RO 3rd, Quyyumi AA, Mincemoyer R, et al. Imipramine in patients with chest pain despite normal coronary angiograms. N Engl J Med 1994;330:1411-7. https://doi.org/10.1056/NEJM199405193302003
  13. Mayou RA, Bass CM, Bryant BM. Management of non-cardiac chest pain: from research to clinical practice. Heart 1999;81:387-92. https://doi.org/10.1136/hrt.81.4.387
  14. Varia I, Logue E, O'Connor C, et al. Randomized trial of sertraline in patients with unexplained chest pain of noncardiac origin. Am Heart J 2000;140:367-72. https://doi.org/10.1067/mhj.2000.108514
  15. Wright RS, Anderson JL, Adams CD, et al. 2011 ACCF/AHA focused update incorporated into the ACC/AHA 2007 Guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in collaboration with the American Academy of Family Physicians, Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons. J Am Coll Cardiol 2011;57:e215-367.
  16. Jeong W, Chang H. Rliability and Validity of Korean Version of Symptom Check list for Minor psychiatric Disorders (SCL-MPD) J Korean Neuropsychiatric Assoc 1987;26:15.
  17. Rohani A, Akbari V, Zarei F. Anxiety and depression symptoms in chest pain patients referred for the exercise stress test. Heart Views 2011;12:161-4. https://doi.org/10.4103/1995-705X.90903
  18. Bass C, Wade C. Chest pain with normal coronary arteries: a comparative study of psychiatric and social morbidity. Psychol Med 1984;14:51-61. https://doi.org/10.1017/S003329170000307X
  19. Ladwig KH, Hoberg E, Busch R. Psychological comorbidity in patients with alarming chest pain symptoms. Psychother Psychosom Med Psychol 1998;48:46-54.
  20. Rozanski A, Blumenthal JA, Kaplan J. Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy. Circulation 1999;99:2192-217. https://doi.org/10.1161/01.CIR.99.16.2192
  21. Watkins LL, Grossman P, Krishnan R, Sherwood A. Anxiety and vagal control of heart rate. Psychosom Med 1998;60:498-502. https://doi.org/10.1097/00006842-199807000-00018
  22. Lown B, Verrier R, Corbalan R. Psychologic stress and threshold for repetitive ventricular response. Science 1973;182:834-6. https://doi.org/10.1126/science.182.4114.834
  23. Ramasubbu R. Insulin resistance: a metabolic link between depressive disorder and atherosclerotic vascular diseases. Med Hypotheses 2002;59:537-51. https://doi.org/10.1016/S0306-9877(02)00244-X
  24. Gold PW, Loriaux DL, Roy A, et al. Responses to corticotropinreleasing hormone in the hypercortisolism of depression and Cushing's disease. Pathophysiologic and diagnostic implications. N Engl J Med 1986;314:1329-35. https://doi.org/10.1056/NEJM198605223142101
  25. Reynolds K, Pietrzak RH, El-Gabalawy R, Mackenzie CS, Sareen J. Prevalence of psychiatric disorders in U.S. older adults: findings from a nationally representative survey. World Psychiatry 2015;14:74-81. https://doi.org/10.1002/wps.20193
  26. D'Agostino RB Sr, Vasan RS, Pencina MJ, et al. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation 2008;117:743-53. https://doi.org/10.1161/CIRCULATIONAHA.107.699579
  27. Chen AC, Dworkin SF, Haug J, Gehrig J. Human pain responsivity in a tonic pain model: psychological determinants. Pain 1989;37:143-60. https://doi.org/10.1016/0304-3959(89)90126-7
  28. Kim JY, Kim N, Seo PJ, et al. Association of sleep dysfunction and emotional status with gastroesophageal reflux disease in Korea. J Neurogastroenterol Motil 2013;19:344-54. https://doi.org/10.5056/jnm.2013.19.3.344
  29. Dempe C, Junger J, Hoppe S, et al. Association of anxious and depressive symptoms with medication nonadherence in patients with stable coronary artery disease. J Psychosom Res 2013;74:122-7. https://doi.org/10.1016/j.jpsychores.2012.12.003
  30. Meyer T, Hussein S, Lange HW, Herrmann-Lingen C. Anxiety is associated with a reduction in both mortality and major adverse cardiovascular events five years after coronary stenting. Eur J Prev Cardiol 2015;22:75-82. https://doi.org/10.1177/2047487313505244

Cited by

  1. Prevalence and Clinical Characteristics of Noncardiac Chest Pain with Reflux Esophagitis in Korea vol.16, pp.2, 2016, https://doi.org/10.7704/kjhugr.2016.16.2.88
  2. Hospitalized Patients with a Therapeutic Profile: The Relationship Between the Type of Attitude Towards Illness and the Quality of Life vol.9, pp.4, 2020, https://doi.org/10.17759/cpse.2020090403