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Almost three-quarters of patients with no coronary heart disease have persistent symptoms

10 Nov, 14 | by ltempler

Investigations seem to worsen anxiety and perpetuate physical pain

Almost three-quarters of patients investigated for coronary heart disease, and given the all-clear, still have persistent symptoms up to 18 months later, indicates a small study published in the online journal Open Heart.

Certain investigations seem to deepen fears about heart health and perpetuate physical symptoms, the findings suggest.

Around one in five patients with chest pain will have no obvious signs of coronary artery disease after investigation, and their symptoms are unlikely to have a physical cause.

But it is not always clear who these patients are, and they often undergo extensive and expensive tests to find out that nothing is wrong with their hearts.

The German authors therefore wanted to test the prevalence of physical and mental symptoms in 253 patients who had been investigated for chest pain/shortness of breath/palpitations and found to have no coronary artery disease.

The type and intensity of their symptoms were tested before  and 6 to 18 months after they had undergone coronary angiography—an invasive procedure designed to take x-ray pictures of the heart.

They also completed a series of validated questionnaires to check on their levels of general anxiety and depression, heart focused anxiety, hypochondria, physical symptoms prompted by state of mind (somatoform disorder) and quality of life.

The results were compared with those of a representative sample of the German population without any history of heart disease.

Before the angiography, symptoms were severe for almost one in 10 patients (more than 8.5%) and moderate in around one in four (28%).

Afterwards, seven out of 10 patients continued to have symptoms, despite having no detectable evidence of coronary artery disease.

Compared with the general population their anxiety levels were considerably higher (37% higher in women and 22% higher in men) and their specific heart focused anxiety was 27% higher.

Similarly, the incidence of somatoform disorders was 120% more common, and these patients were 68% more likely to be suffering from hypochondria. Unsurprisingly, their stress and anxiety levels were reflected in significantly lower quality of life scores.

The researchers conclude that while the validated questionnaires take a bit of time to complete, they are worth doing to stave off the likelihood of further expensive and potentially invasive tests and to ensure that these patients get the psychological help they need.


Dr Marian Christoph

6 Nov, 14 | by ltempler

This is the first in our series of author profiles. Please let me introduce you to Dr Marian Christoph who published the paper “Mental symptoms in patients with cardiac symptoms and normal coronary arteries” which can be found here.Dr Marian Christoph

Hi Dr Christoph please can you tell us a bit about yourself and how you got started in scientific research?

I started in science drawing up my doctoral thesis in cardiovascular research in 2001. Since 2005 I´m working in the Heart Center of the University Hospital Dresden. During this period I published several papers on a variety of areas of cardiology.

What made you focus on this specific area?

During the last years I often saw patients suffering from chest pain, which were admitted to our hospital for coronary angiography. Despite of angiographic exclusion of a coronary heart disease numerous patients had persistent complaints. Therefore, together with my co-authors we set up the hypothesis, that many patients suffering from chest pain without coronary heart disease could suffer from mental disorders as cause of their persistent complaints.

 What are the messages we should take from your paper?

The most important fact of the current study is, that 70% of patients continue to suffer from chest pain, despite of an angiographic exclusion of a coronary heart disease.

If we want to help these 70% of patients we have to look for differential diagnoses! The current study could show that psychosomatic symptoms are very often in these patients. Therefore we should screen these patients for this kind of disorders. Therefore standardized psychosomatic questionnaires are very practicable, even for cardiologists.

 And what limitations should we be aware of?

The interpretability of the results is reduced because the health status of the participants was only measured using subjective ratings. A full psychiatric examination of the patients using a standardized Interview like SCID-I/II (Structured Clinical Interview for DSM-IV) was not performed

What impact will your study have on the field?

We hope, that this manuscript convince some practical cardiologists to screen chest pain patients without a coronary heart disease for mental disorders. The study shows, that this diagnostic tool is very practicable .

What still needs to be done in the field?

We need a closer cooperation between cardiologists and psychosomatics for better diagnosis and treatment of chest pain patients without coronary heart disease. The cardiologists should perform an early screening for mental symptoms and should transfer the positive patients to psychosomatics for further diagnostic and treatment.



The Open Heart blog

15 Sep, 14 | by BMJ

Welcome to the Open Heart blog. Over the coming weeks we will be introducing you to some of our key published authors. This is part of our new “author profiles” feature where you can find out more about their work, their interests and their advice for other people starting out in their field.

I will also be re-posting some of the journals key press releases and editorials selected by our Editor-in-Chief Pascal Meier.

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