Frequent Chest Pain Linked to Anxiety and Depression

A new study shows that heart patients with depression and anxiety are more likely to suffer chest pain than patients without those symptoms. The findings, published in the June 30 edition of Circulation, also suggest that angina associated with blocked arteries may also have a psychosocial component.

Coronary artery disease patients with even moderate anxiety were four times more likely to have angina (chest pain), whereas patients with clinical depression were three times more likely to have frequent angina.

The results suggest that some patients’ anginal symptoms might have a psychosomatic origin and not be directly related to the extent of their heart disease, wrote Mark Sullivan, MD, PhD, a professor at the University of Washington School of Medicine, and colleagues.

The researchers assessed 788 patients (mean age of 63) who were undergoing single-photo emission computed tomography stress imaging at two Seattle hospitals between April 2004 and 2006. Of those, 191 were determined to have inducible ischemia (when blood flow to the heart is obstructed). The patients completed a questionnaire to determine the frequency of their chest pain over the previous four weeks and took psychosocial assessments, including a self-reported anxiety and depression questionnaire.

Among the patients with ischemia, 68 (36%) reported no angina over the previous four weeks, while 66 (35%) reported monthly symptoms, and 57 (30%) had weekly or daily angina. Younger patients reported more frequent angina.

After adjusting for the degree of myocardial ischemia, the researchers found that more frequent angina was significantly associated with previous coronary revascularization, greater anxiety scores, and greater depression scores.

The researchers noted that the mechanism of the association between angina and anxiety and depression remains unclear. They also cited previous research involving patients with no ischemia who reported angina related to depression and anxiety, and suggested that psychological distress might add to the pain heart patients experience from their condition.

They also pointed out that depression and anxiety have been tied to worsening of symptoms in patients with other chronic illnesses. Other researchers have suggested that this is the result of decreased activity in the descending pain inhibitory circuits of the central nervous system.

Although U.S. physicians typically use medication and revascularization to reduce myocardial ischemia, European physicians use a broader range of treatments, including cognitive-behavioral therapy, medication, and rehabilitation programs similar to those used for chronic pain.

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