Skip to main content
Log in

Cardiac Anxiety in Patients Self-Referred for Electron Beam Tomography

  • Published:
Journal of Behavioral Medicine Aims and scope Submit manuscript

Abstract

Studies have repeatedly shown that as many as 43% of patients undergoing coronary angiograms have no evidence of coronary heart disease (CHD). Fear of cardiac-related sensations has been posited as one explanation for complaints of chest pain in patients without CHD. The purpose of this study is to examine variables associated with cardiac anxiety in a sample of individuals self-referred for noninvasive coronary calcium screening. Nearly one quarter of the subjects screened experienced chest pain in the absence of coronary artery calcium (CAC). Individuals without evidence of CAC were more likely to report higher levels of heart-focused attention, even when subjects with any risk factors for CHD were excluded from the analyses. Men were more likely to have evidence of coronary calcium, although a greater proportion of women reported chest pain. Women generally endorsed higher levels of cardioprotective behavior, heart-focused attention, and fear of heart-related sensations. Findings are discussed in relation to treatment of cardiac anxiety and the prevention of unnecessary medical procedures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Agatson, A. S., Janowitz, W. R., Hildner, F. J., Zusmer, N. R., Viamonte, J. J., and Detrano, R. (1990). Quantification of coronary artery calcium using ultrafast computed tomography. J. Am. Coll. Cardiol. 15: 827–832.

    PubMed  Google Scholar 

  • Agatson, A. S., Janowitz, W. R., Kaplan, G. S., Lee, D., Prashad, R., and Viamonte, M. (1996). Electron beam CT coronary calcium predicts future coronary events. Circulation 94: 1–360.

    PubMed  Google Scholar 

  • Aikens, J. E., Michael, E., Levin, T., and Lowry, E. (1999). The role of cardioprotective avoidance beliefs in noncardiac chest pain and associated emergency department utilization. J. Clin. Psychol. Med. Sett. 6(4): 317–332.

    Google Scholar 

  • Aikens, J. E., Wagner, L. I., Setzer, N. S., and Smith, A. (1997). Panic disorder recognition and management by primary care physicians. Ann. Behav. Med. 19: S172.

    Google Scholar 

  • Allen, R. (1996). Introduction: The emergence of cardiac psychology. In Allen, R., and Scheidt, S. (Eds.), Heart & Mind: The Practice of Cardiac Psychology, American Psychological Association, Washington, DC, pp. 3–14.

    Google Scholar 

  • Allen, R., and Scheidt, S. (1996). Empircal basis for cardiac psychology. In Allen, R., and Scheidt, S. (Eds.), Heart & Mind: The Practice of Cardiac Psychology, American Psychological Association, Washington, DC, pp. 62–123.

    Google Scholar 

  • Arad, Y., Spadaro, L. A., Goodman, K., Lledo-Perez, A., Sherman, S., Lerner, G., and Guerci, A. D. (1996). Predictive value of electron beam computed tomography of the coronary arteries: 19–Month follow-up of 1173 asymptomatic subjects. Circulation 93: 1951–1953.

    PubMed  Google Scholar 

  • Barlow, D. H. (1988). Anxiety and Its Disorders, Guilford, New York.

    Google Scholar 

  • Bass, C., Wade, C., Hand, D., and Jackson, G. (1983). Patients with angina with normal and near normal coronary arteries: Clinical and psychosocial state 12 months after angiography. BMJ 287: 1505–1507.

    PubMed  Google Scholar 

  • Beck, J. G., Berisford, M. A., Taegtmeyer, H., and Bennett, A. (1990). Panic symptoms in chest pain without coronary artery disease: A comparison with panic disorder. Behav. Ther. 21: 241–252.

    Google Scholar 

  • Beitman, B. D., Mukerji, V., Lamberti, J. W., Schmid, L., DeRosear, L., Kasner, M., Flaker, G., and Basha, I. (1989). Panic disorder in patients with chest pain and angiographically normal coronary arteries. Am. J. Cardiol. 63: 1399–1403.

    PubMed  Google Scholar 

  • Cannon, R. O., III. (1995). The sensitive heart: A syndrome of abnormal cardiac pain perception. JAMA, 273: 883–887.

    PubMed  Google Scholar 

  • Cannon, R. O., III, and Balaban, R. S. (2000). Chest pain in women with normal coronary angiograms. N. Engl. J. Med. 342: 885–887.

    PubMed  Google Scholar 

  • Carter, C., Maddock, R., Zoglio, M., Lutrin, C., Jella, S., and Amsterdam, E. (1994). Panic disorder and chest pain: a study of cardiac stress scintigraphy patients. Am. J. Cardiol. 74(3): 296–298.

    PubMed  Google Scholar 

  • Carter, C. S., Servan-Schrieber, D., and Perlstein, W. M. (1997). Anxiety disorders and the syndrome of chest pain with normal coronary arteries: Prevalence and pathophysiology. J. Clin. Psychiatry 58(Suppl.): 70–73.

    PubMed  Google Scholar 

  • Clark, D. M. (1989). Anxiety states: Panic and generalized anxiety. In Hawton, K., Salkovskis, P. M., Kirk, J., and Clark, D. M. (Eds.), Cognitive Behaviour Therapy for Psychiatric Problems: A Practical Guide, Oxford University Press, Oxford, UK, pp. 52–96.

    Google Scholar 

  • Dammen, T., Arnesen, H., Ekeberg, O., Husebye, T., and Friis, S. (1999). Panic disorder in chest pain patients referred for cardiological outpatient investigation. J. Intern. Med. 245: 497–507.

    PubMed  Google Scholar 

  • Detrano, R., Hsiai, T., Wang, S., Puentes, G., Fallavollita, J., Shields, P., Stanford, W., Wolfkiel, C., Georgiou, D., Budoff, M., and Reed, J. (1996). Prognostic value of coronary calcification and angiographic stenoses in patients undergoing coronary angiography. J. Am. Coll. Cardiol. 27: 285–290.

    PubMed  Google Scholar 

  • Devries, S., Wolfkiel, C., Shah, V., Chomka, E., and Rich, S. (1995). Reproducibility of the measurement of coronary artery calcium with ultrafast computed tomography. Am. J. Cardiol. 75: 973–975.

    PubMed  Google Scholar 

  • Eifert, G. H., Hodson, S. E., Tracey, D. R., and Seville, J. L. (1996). Heart-focused anxiety, illness beliefs, and behavioral impairment: Comparing healthy heart-anxious patients with cardiac and surgical inpatients. J. Behav. Med. 19(4): 385–399.

    PubMed  Google Scholar 

  • Eifert, G. H., Thompson, R. N., Zvolensky, J. J., Edwards, K., Haddad, J. H., Frazer, N. L., and Kavig, J. (2000a). The Cardiac Anxiety Questionnaire: Development and preliminary validity. Behav. Res. Ther. 38: 1039–1053.

    PubMed  Google Scholar 

  • Eifert, G. H., Zvolensky, J. J., and Lejuez, C. W. (2000b). Heart-focused anxiety and chest pain: A conceptual and clinical review. Clin. Psychol. Sci. Pract. 7: 403–417.

    Google Scholar 

  • Fallavollita, J. A., Brody, A. S., Bunnell, I. L., Kumar, K., and Canty, J. M. (1994). Fast computed tomography detection of coronary calcification in the diagnosis of coronary artery disease: Comparison with angiography in patients <50 years old. Circulation 89: 285–290.

    PubMed  Google Scholar 

  • Farmer, J. A., and Gotto, A. M., Jr. (1997). Dyslipidemia and other risk factors for coronary artery disease. In Braunwald, E.(Ed.), Heart Disease: A Textbook of Cardiovascular Medicine, (5th ed.), W. B. Saunders Company, Philadelphia, pp. 1126–1160.

    Google Scholar 

  • Fleet, R. P., Dupuis, G., Marchand, A., Burelle, D., and Beitman, B. D. (1994). Panic disorder, chest pain and coronary artery disease: Literature review. Can. J. Cardiol. 10: 827–834.

    PubMed  Google Scholar 

  • Fleet, R. P., Dupuis, G., Marchand, A., Kacaorowski, J., Burelle, D., Arsenault, A., and Beitman, B. D. (1998). Panic disorder in coronary artery disease patients with noncardiac chest pain. J. Psychosom. Res. 44: 81–90.

    PubMed  Google Scholar 

  • Frasure-Smith, N., Lesperance, F., and Talajic, M. (1993). Depression following myocardial infarction: Impact on 6–month survival. J. Am. Med. Assoc. 270: 1819–1861.

    Google Scholar 

  • Frasure-Smith, N., Lesperance, F., and Talajic, M. (1995). Depression and 18–month prognosis after myocardial infarction. Circulation 91: 999–1005.

    PubMed  Google Scholar 

  • Frasure-Smith, N., Lesperance, F., and Talajic, M. (2000). The prognostic importance of depression, anxiety, anger, and social support following myocardial infarction: Opportunities for improving survival. In McCabe, P. M., Schneiderman, N., Field, T., and Wellens, R. (Eds.), Stress, Coping, and Cardiovascular Disease, (pp. 203–228). Mahwah, NJ: Erlbaum.

    Google Scholar 

  • Guerci, A. D., Spadaro, L. A., Popma, J. J., Goodman, K. J., Brundage, B. H., Lerner, G., and Vizza, R. F. (1997). Relation of coronary calcium score by electron beam computed tomography to arteriographic findings in asymptomatic and symptomatic adults. Am. J. Cardiol. 79: 128–133.

    PubMed  Google Scholar 

  • Janowitz, W. R., Agatston, A. S., Kaplan, G., and Viamonte, M. (1993). Differences in prevalence and extent of coronary artery calcium detected by ultrafast computed tomography in asymptomatic men and women. Am. J. Cardiol. 72: 247–254.

    PubMed  Google Scholar 

  • Kajinami, K., and Takekoshi, N. (1995). Noninvasive prediction of coronary atherosclerosis by quantification of coronary artery calcification using electron beam computed tomography: Comparison with electrocardiographic and thallium exercise stress test results. J. Am. Coll. Cardiol. 25: 626–632.

    PubMed  Google Scholar 

  • Katon, W., Hall, M. L., Russo, J., Cormier, L., Hollifield, A., Vitaliano, P. P., and Beitman, B. D. (1988). Chest pain: Relationship of psychiatric illness to coronary arteriographic studies. Am. J. Med. 84: 1–9.

    Google Scholar 

  • Kubzansky, L. D., Kawachi, I., Weiss, S. T., and Sparrow, D. (1998). Anxiety and coronary heart disease: A synthesis of epidemiological, psychological, and experimental evidence. Ann. Behav. Med. 20: 47–58.

    PubMed  Google Scholar 

  • Laudon, D. A., Vukov, L. F., Breen, J. F., and Sheedy, P. F. (1999). The cost-effectiveness of electron beam computed tomography in the evaluation of chest pain in the emergency department observation units. Ann. Emerg. Med. 34: S5–S6.

    Google Scholar 

  • Mautner, S. L., Mautner, G. C., Froehlich, J., Feuerstein, I. M., Proschan, M. A., Roberts, W. C., and Doppman, J. L. (1994). Coronary artery disease: Prediction with in vitro electron beam CT. Radiology 192: 625–630.

    PubMed  Google Scholar 

  • McLaughlin, V. V., Balough, T., and Rich, S. (1999). Utility of electron beam computed tomography to stratify patients presenting to the emergency room with chest pain. Am. J. Cardiol. 84: 327–328.

    PubMed  Google Scholar 

  • Mineka, S., Watson, D., and Clark, L. A. (1998). Comorbidity of anxiety and unipolar affective disorders. Ann. Rev. Psychol. 48: 377–412.

    Google Scholar 

  • Musselman, D. L., Evans, D. L., and Nemeroff, C. B. (1998). The relationship of depression and cardiovascular disease: Epidemiology, biology, and treatment. Arch. Gen. Psychiatry 55: 580–592.

    PubMed  Google Scholar 

  • Rumberger, J. A., Schwartz, R. W., Simons, D. B., Sheedy, P. F., III, Edwards, W. D., and Fitzpatrick, L. A. (1994). Relation of coronary calcium determined by electron beam computed tomography and lumen narrowing determined by autopsy. Am. J. Cardiol. 73: 1169–1170.

    PubMed  Google Scholar 

  • Rumberger, J. A., Sheedy, P. F., Breen, J. F., and Schwartz, R. S. (1995a). Coronary calcium, as determined by electron beam computed tomography, and coronary disease on arteriogram: Effect of patient's sex on diagnosis. Circulation 91: 1363–1367.

    PubMed  Google Scholar 

  • Rumberger, J. A., Simons, B. D., Fitzpatrick, L. A., Sheedy, P. F., and Schwartz, R. S. (1995b). Coronary artery calcium area by electron-beam computed tomography and coronary athereosclerotic plaque area: A histopathologic correlative study. Circulation 92: 2157–2162.

    PubMed  Google Scholar 

  • Secci, A., Wong, N., Tang, W., Wang, S., Doherty, T., and Detrano, R. (1997). Electron beam computed tomographic coronary calcium as a predictor of coronary events: Comparison of two protocols. Circulation 96: 1112–1129.

    Google Scholar 

  • Simons, D. B., Schwartz, R. S., Edwards, W. D., Sheedy, P. F., Breen, J. F., and Rumberger, J. A. (1992). Noninvasive definition of anatomic coronary artery disease by ultrafast computed tomographic scanning: A quantitative pathologic comparison study. J. Am. Coll. Cardiol. 20: 1118–1126.

    PubMed  Google Scholar 

  • Wong, N. D., Vo, A., Abrahamson, D., Tobis, J. M., Eisenberg, H., and Detrano, R. C. (1994). Detection of coronary artery calcium by ultrafast computed tomography and its relation to clinical evidence of coronary artery disease. Am. J. Cardiol. 73: 223–227.

    PubMed  Google Scholar 

  • Wulsin, L. R., Hillard, J. R., Geier, P., Hissa, D., and Rouan, G. W. (1988). Screening emergency room patients with atypical chest pain for depression and panic disorder. Int. J. Psychiatry Med. 18(4): 315–323.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Cheryl N. Carmin.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Carmin, C.N., Wiegartz, P.S., Hoff, J.A. et al. Cardiac Anxiety in Patients Self-Referred for Electron Beam Tomography. J Behav Med 26, 67–80 (2003). https://doi.org/10.1023/A:1021747106450

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1021747106450

Navigation