Unexplained chest pain. Future directions for research

Somatic awareness and coronary artery disease in women with chest pain

OBJECTIVE

To determine if there was a relationship between level of somatic awareness and coronary artery disease (CAD) in women with chest pain.

DESIGN

Descriptive, correlational study.

SETTING

Urban, university-affiliated, tertiary care hospital.

SAMPLE

Fifty-five women without a previous history of heart disease admitted to the hospital for evaluation of chest pain.

MEASURES

Modified Somatic Perception Questionnaire (MSPQ); Patterson and Horowitz clinical criteria for classification of chest pain; Supplemented Rose Questionnaire for angina; age; and CAD risk factors.

RESULTS

A small but significant inverse correlation was found between level of somatic awareness as measured by MSPQ scores and degree of CAD (r = 0.2932, p < 0.05). MSPQ scores significantly differed between women with CAD (lower scores) and women without CAD (higher scores) (p < 0.05). MSPQ score was the most important factor in a logistic regression model that modestly but significantly predicted presence or absence of CAD.

CONCLUSIONS

Somatic awareness may be an important factor to consider in evaluating the awareness and response of women to symptoms of myocardial ischemia and to chest pain of both cardiac and noncardiac etiologies.

Chest pain in generalized anxiety disorder

OBJECTIVES

The objectives of the current study were to evaluate the prevalence of chest pain and related medical utilization in patients with generalized anxiety disorder and to investigate the possible relationship between the occurrence of chest pain in these patients and the episodes of excessive worry which characterize this disorder.

METHOD

The presence of a history of chest pain in patients with generalized anxiety disorder was investigated in an outpatient psychiatric sample using a structured interview which also assessed related medical utilization and the relationship of chest pain to panic attacks and episodes of excessive worry.

RESULTS

Of fifty sequentially evaluated patients meeting DSM-III R criteria for G.A.D., twenty-four (48%) reported a history of chest pain. Seven of these patients also had a history of panic attacks, however, four of the seven reported that their pain occurred independently of their panic attacks. Sixteen patients with G.A.D. reported that their chest pain episodes were associated with episodes of excess worry. Eleven had sought medical evaluation for their pain. Patients with chest pain and normal coronary arteries are frequently found to have panic disorder. The pattern of utilization of medical care was comparable in this sample of patients with G.A.D. and a group of patients with panic disorder recruited in a similar manner.

CONCLUSIONS

These results suggest that in addition to panic disorder, G.A.D. may also be a common diagnosis in chest pain patients with no demonstrable coronary disease. Future studies of coronary artery disease negative patients with chest pain should include assessments for the presence of G.A.D. Our results also suggest that chest pain may be a common symptom in G.A.D. The possibility that chest pain should be included in the diagnostic criteria for this disorder should be the subject of further investigation.