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Mental symptoms common in patients with cardiac symptoms, normal arteries
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Patients who experience chest pain but have normal coronary arteries are more likely to experience mental symptoms than the healthy population, according to recent findings.
Researchers evaluated 253 consecutive patients (156 women; mean age, 64.5 years) who presented with cardiac symptoms at the Heart Centre at the University of Dresden, Germany. All patients underwent coronary angiography to rule out the presence of CAD. After catheterization, the presence of mental symptoms was evaluated using the following validated questionnaires:
- The Screening for Somatoform Disorders (SOMS), which records the presence of 53 physical symptoms from the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), without an attributable organic cause;
- The Whitely Index, a 14-item questionnaire assessing hypochondriacal tendencies;
- The Hospital Anxiety and Depression Scale (HADS), which evaluates symptoms of anxiety and depression;
- The Cardiac Anxiety Questionnaire (CAQ), which focuses on anxiety specifically related to cardiac symptoms; and
- The Short-Form Health Survey (SF-12), which addresses quality of life relative to physical and mental health.
Researchers compared results from these patients with age-matched controls without a history of CAD. The researchers also evaluated the type and intensity of the presenting cardiac symptoms among patients before and after coronary angiography.
Fifty-five percent of patients reported chest pain, 35.4% experienced dyspnea and 39.4% reported heart palpitations. Despite the absence of CAD, 70% of patients continued to report cardiac symptoms after cardiac catheterization, although many experienced a reduction in symptom severity.
Results from all questionnaires, excluding the HADS depression scale, indicated higher values among patients compared with controls. CAQ-Total scores were 27% higher among patients (P<.001). Anxiety as measured by HADS was significantly higher among both men (22% relative difference; P=.003) and women (37%; P<.001) compared with healthy controls. SOMS scores were 120% higher among patients with noncardiac chest pain while Whitley Index values were 68% higher (P<.001 for both). Quality of life as indicated by the SF-12 questionnaire was lower among men and women, with decreases of 8.8% for physical quality of life scores and 5.8% for psychological quality of life among men, and of 13% and 8%, respectively, among women.
The researchers concluded that psychosomatic screening via these questionnaires may be valuable in this patient population and should be performed early in the treatment process.
“These standardized questionnaires are very practicable, even for internal wards,” the researchers wrote. “These diagnostic tools may prevent repeated utilization of the health care system, and this could help to reduce costs for these patients due to initiation of an early psychosomatic therapy.”
Disclosure: The researchers report no relevant financial disclosures.
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