The anxious patient with cardiovascular symptomatology

Overview

The authors submit a review of typical chest symptoms of patients suffering from anxious disorders. The relationship of our emotion – especially of anxiety, depression, and anger – to heart activity is intriguing. Over one third of patients with unstable angina and after myocardial infarction experienced elevated anxiety at the time of the ischemic event, and these symptoms persisted for 1 year in 50% of anxious patients. On the other hand psychosocial stress and anxiety induce adverse changes in autonomic tone accounting for substantial but modifiable cardiovascular risk. There is also frequent commorbidity of anxious disorders and coronary heart disease, arrhytmias and sudden cardiac death.

The authors describe factors influencing chest pain expression in patients with cardiac or anxious disease and offer the useful algorhitm of diagnostic and therapeutic methods which minimize the risk of omission (neglect some serious cardiac problems), as well as commission (worsening of anxious and hypochondrical attitudes of these patients).

Key words:
anxiety – anxiety disorders – chest pain – diagnosis – treatment – cardiac disease – noncardiac disease – MUS.