Hostname: page-component-8448b6f56d-m8qmq Total loading time: 0 Render date: 2024-04-19T00:40:07.726Z Has data issue: false hasContentIssue false
  • English
  • Français

Psychological morbidity in patients with chest pain and normal or near-normal coronary arteries: a long-term follow-up study

Published online by Cambridge University Press:  09 July 2009

S. G. Potts  and
C. M. Bass
S. G. Potts*
Affiliation:
Department of Psychological Medicine, King's College Hospital, London
C. M. Bass
Affiliation:
Department of Psychological Medicine, King's College Hospital, London
*
1Address for Correspondence. Dr S. G. Potts, University Department of Psychiatry, Royal Edinburgh Hospital, Morningside Park, Edinburgh EH10 5ED.
Get access Rights & Permissions [Opens in a new window]

Synopsis

Forty-six patients with chest pain but normal or near-normal coronary arteries were assessed using standardized interviews and rating scales at the time of angiography, after 1 year, and again 11·4 years later. Psychological morbidity was substantial and enduring: 61% of patients were designated as psychiatric cases at angiography and 49% at 11·4 years. Both at the time of angiography, and 1 year later, levels of morbidity were significantly greater than in a control group of 53 patients with coronary artery disease. Anxiety disorders were common at all three interviews, with panic disorder (15% of patients) the most common current diagnosis at final follow-up. Current somatoform disorders were diagnosed in 9 patients (22%), and 11 (27 %) reported previous episodes of major depression. Psychological morbidity was associated with continuing chest pain, which was reported in 74% of patients, and with ongoing functional incapacity. These findings suggest that, in a sub-group of these patients, psychological factors contribute in part to the development of chest pain and other physical symptoms, and are also important in maintaining the disorder over long periods. Further research is now required to identify more fully the nature of these psychological factors, and how they interact with cardiac and non-cardiac physical pathology. There is also an urgent need to examine the clinical and economic benefits of specific psychological interventions.

Type
Original Articles
Information
Psychological Medicine , Volume 25 , Issue 2 , March 1995 , pp. 339 - 347
Copyright
Copyright © Cambridge University Press 1995

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alban Davies, H. (1992). Anginal pain of oesophageal origin: clinical presentation, prevalence, and prognosis. American Journal of Medicine 92 (suppl. 5A), 5S–11S.CrossRefGoogle Scholar
Bass, C. (1984). Psychosocial outcome after coronary artery surgery. British Journal of Psychiatry 145, 526–532.CrossRefGoogle Scholar
Bass, C. (1991). Unexplained chest pain and breathlessness. Medical Clinics of North America 75, 1157–1173.CrossRefGoogle ScholarPubMed
Bass, C. & Mayou, R. (1995). Chest pain and palpitations. In Treatment of Functional Somatic Symptoms (ed. Mayou, R., Bass, C. and Sharpe, M.). Oxford University Press: Oxford. (In the press.)Google Scholar
Bass, C., Cawley, R., Wade, C., Ryan, K. C., Gardner, W. N., Hutchison, D. C. S. & Jackson, G. (1983 a). Unexplained breath lessness and psychiatric morbidity in patients with normal and abnormal coronary arteries. Lancet i, 605–609.CrossRefGoogle Scholar
Bass, C., Wade, C., Hand, D. & Jackson, G. (1983 b). Angina with normal and near-normal coronary arteriograms: clinical and psychosocial state 12 months after angiography. British Medical Journal ii, 1505–1508.CrossRefGoogle Scholar
Beitman, B. D., Murkerji, V., Lamberti, J. W., Scmid, L., De Rosear, L., Kushner, M., Flaker, G. & Basha, I. (1989). Panic disorder in patients with chest pain and angiographically normal coronary arteries. American Journal of Cardiology 63, 1399–1403.CrossRefGoogle ScholarPubMed
Beitman, B. D., Kushner, M. G., Basha, I., Lamberti, J., Mukerji, V. & Bartels, K. (1991). Follow-up status of patients with angiographically normal coronary arteries and panic disorder. Journal of the American Medical Association 265, 1545–1549.CrossRefGoogle ScholarPubMed
Cannon, R. O., Camici, P. G. & Epstein, S. E. (1992). Pathophysiological dilemma of syndrome X. Circulation 85, 883–896.CrossRefGoogle ScholarPubMed
Carney, R. M., Freedland, K. E., Ludbrook, P. A., Saunders, R. D. & Jaffe, A. S. (1990). Major depression, panic disorder, and mitral valve prolapse in patients who complain of chest pain. American Journal of Medicine 89, 757–761.CrossRefGoogle ScholarPubMed
Chambers, J. B. & Bass, C. (1990). Chest pain with normal coronary anatomy: a review of natural history and possible etiologic factors. Progress in Cardiovascular Diseases 33, 161–184.CrossRefGoogle ScholarPubMed
Channer, K. S., James, M. A., Papouchado, M. & Russell Rees, J. (1987). Failure of a negative exercise test to reassure patients with chest pain. Quarterly Journal of Medicine 63, 315–322.Google ScholarPubMed
Derogatis, L. R. (1983). SCL-90R Administration, Scoring and Procedure Manual-II. Clinical Psychometric Research: Baltimore.Google Scholar
Goldberg, D. B., Cooper, B., Eastwood, M. R., Kedward, H. B. & Shepherd, M. (1970). A standardized psychiatric interview for use in community surveys. British Journal of Preventive and Social Medicine 24, 18–23.Google ScholarPubMed
Katon, W., Hall, M. L., Russo, J., Cormier, L., Hollifield, M., Vitaliano, P. P. & Beitman, B. D. (1988). Chest pain: relationship of psychiatric illness to coronary arteriographic results. American Journal of Medicine 84, 1–9.CrossRefGoogle ScholarPubMed
Kemp, H. G., Kronmal, R. A., Vlietstra, R. E., Frye, R. L. & The Coronary Artery Surgery Study (CASS) Participants (1986). Sevenyear survival of patients with normal or near normal coronary arteriograms. A CASS registry study. Journal of the American College of Cardiologists 7, 479–483.CrossRefGoogle ScholarPubMed
Klimes, I., Mayou, R. A., Pearce, M. J., Coles, L. & Fagg, J. R. (1990). Psychological treatment for atypical non-cardiac chest pain: a controlled evaluation. Psychological Medicine 20, 605–611.CrossRefGoogle ScholarPubMed
Lantinga, L. J., Sprafkin, R. P., McCroskery, J. H., Baker, M. T., Warner, R. A. & Hill, N. E. (1988). One-year psychosocial follow-up of patients with chest pain and angiographically normal coronary arteries. American Journal of Cardiology 62, 209–213.CrossRefGoogle ScholarPubMed
Lavey, E. B. & Winkle, R. A. (1979). Continuing disability of patients with chest pain and normal coronary arteriograms. Journal of Chronic Disease 32, 191–195.CrossRefGoogle ScholarPubMed
Lynch, P., Bakal, D. A., Whitelaw, W. & Fung, T. (1991). Chest muscle activity and panic anxiety: a preliminary investigation. Psychosomatic Medicine 53, 80–89.CrossRefGoogle ScholarPubMed
Potts, S. G. & Bass, C. M. (1993). Psychosocial outcome and use of medical resources in patients with chest pain and normal or nearnormal coronary arteries: a long-term follow-up study. Quarterly Journal of Medicine 86, 583–593.Google ScholarPubMed
Potts, S. G. & Bass, C. (1994). Chest pain with normal coronary arteries: psychological aspects. In Angina Pectoris with Normal Coronary Arteries: Syndrome X. (ed. Kaski, J.), pp. 65–88. Kluwer Academic Publishers: Boston.CrossRefGoogle Scholar
Proudfit, W. L., Bruschke, A. V. G. & Sones, F. M. J. (1980). Clinical course of patients with normal or slightly or moderately abnormal coronary arteriograms: 10 year follow-up of 152 patients. Circulation 62, 712–717.CrossRefGoogle ScholarPubMed
Spitzer, R. L. & Williams, J. R. (1983). Structured Clinical Interview for DSM-III. New York State Psychiatric Institute: New York.Google Scholar
Sullivan, A. M., Holdright, D. R., Wright, C. A., Sparrow, J. L., Cunningham, D., Fox, K. M. (1994). Chest pain in women: clinical investigative and prognostic features. British Medical Journal 308, 883–886.CrossRefGoogle ScholarPubMed
Wise, C. M., Semble, E. L. & Dalton, C. B. (1992). Musculoskeletal chest wall syndromes in patients with noncardiac chest pain: a study of 100 patients. Archives of Physical Medicine and Rehabilitation 73, 147–149.Google ScholarPubMed