Use of the hospital anxiety and depression scale (HADS) in a cardiac emergency room: chest pain unit

The Degree of Anxiety and Depression in Patients With Cardiovascular Diseases as Assessed Using a Mobile App: Cross-Sectional Study

BACKGROUND

Depression and anxiety are common comorbidities in cardiovascular clinic outpatients. Timely identification and intervention of these mental and psychological disorders can contribute to correct diagnosis, better prognosis, less medical expenses, and improved quality of life. The convenience of online doctor-patient communication platforms has increasingly attracted patients to online consultations. However, online health care and offline health care are very different. Research on how to identify psychological disorders in patients who engage in an online cardiology consultation is lacking.

OBJECTIVE

This study aimed to explore the feasibility of using a self-rating scale to assess mental illness among patients who consult with a cardiologist online and to compare the differences in anxiety and depression between online and offline patients.

METHODS

From June 2022 to July 2022, we conducted follow-up visits with 10,173 patients on the Haodf platform. We conducted detailed consultations with 286 patients who visited the same cardiologist in the outpatient department. We used the self-rated Generalized Anxiety Disorder (GAD-7) and Patient Health Questionnaire (PHQ-9) scales to assess anxiety and depression, respectively. We analyzed the influencing factors related to the degree of coordination of online patients. We also compared the prevalence of anxiety or depression between online and offline patients and analyzed the factors related to anxiety or depression.

RESULTS

Of the 10,173 online consultation patients, only 186 (1.8%) responded effectively. The response rate of the offline consultation patients was 96.5% (276/286). Frequent online communication and watching live video broadcasts were significantly related to effective responses from online patients (P<.001). The prevalence of anxiety (70/160, 43.7% vs 69/266, 25.8%; P<.001) or depression (78/160, 48.7% vs 74/266, 27.7%; P<.001) in online consultation patients was significantly higher than that in offline patients. In bivariate analyses, the factors related to anxiety included female sex, unemployment, no confirmed cardiovascular disease, and the online consultation mode, while smokers and those who underwent COVID-19 quarantine were less likely to present with anxiety. The factors related to depression included female sex, divorced or separated individuals, and the online consultation mode. COVID-19 quarantine was related with a lower likelihood of depression. BMI was negatively correlated with depression. In multiple ordered logistic regression analysis, women were more likely than men to present with anxiety (odds ratio [OR] 2.181, 95% CI 1.365-3.486; P=.001). Women (OR 1.664, 95% CI 1.082-2.559; P=.02) and online patients (OR 2.631, 95% CI 1.305-5.304; P=.007) were more likely to have depression.

CONCLUSIONS

Online patients had more anxiety or depression than offline patients. Anxiety was more prevalent in women, the unemployed, and those without confirmed cardiovascular disease. Women and divorced or separated individuals were more prone to depression. Increasing the frequency of doctor-patient communication and participating in video interactions can help improve patient cooperation.

A novel intubation discomfort score to predict painful unsedated colonoscopy

Pain during colonoscopy is a critical quality indicator and often a limiting factor for unsedated colonoscopy. This study aimed to identify factors associated with pain during colonoscopy and establish a model for predicting a painful colonoscopy.Patients aged 18 to 80 who underwent unsedated colonoscopy were prospectively enrolled in 2 tertiary endoscopic centers in China. The primary outcome was the rate of painful colonoscopy and then we identify high-risk factors associated with painful colonoscopy. A prediction model with an intubation discomfort score (IDS) was developed and validated.Totally 607 patients participated in this study, including 345 in the training cohort and 262 in the validation cohort. Body mass index (BMI) of <18.5 kg/m2 (OR 2.18, 95% CI: 1.09-4.37), constipation (OR 2.45, 95% CI: 1.25-4.80), and anticipating moderate or severe pain (OR 2.06, 95% CI: 1.12-3.79) were identified as independent predictive factors for painful colonoscopy and used to develop the IDS (all P < .05). Patients with IDS ≥1 had increased insertion time [9.32(6.2-13.7)] minutes vs 6.87(5.1-10.4) minutes, P = .038) and decreased cecal intubation rate (96.0% vs 99.6%, P = .044). Abdominal compression (48.4% vs 19.9%, P < .001) and position change (59.7% vs 32.1%, P < .001) were more frequently required in the group of patients with IDS ≥1. These results were externally validated in a validation cohort.The intubation discomfort score developed in this study was useful for predicting pain during colonoscopy, with IDS ≥1 indicating painful colonoscopy.

Important relation between self-efficacy, sense of coherence, illness perceptions, depression and anxiety in patients with inflammatory bowel disease

INTRODUCTION

Anxiety and depression are common disturbances in patients with inflammatory bowel diseases (IBD), and were found to impact the disease course. Illness perceptions (IPs), self-efficacy (SE) and sense of coherence (SOC) are important psychological functions, used by the individual to cope with his chronic disease.

AIMS

to investigate the association of IP, SE and SOC on anxiety and depression among patients with IBD.

PATIENTS AND METHODS

Patients filled questionnaires including: demographic, socioeconomic and clinical features. Depression and anxiety were assessed using the Hospital Anxiety and Depression Scale. IP, SE and SOC were assessed using the Brief Illness perception Questionnaire, IBD-SE and SOC scales.

RESULTS

The study sample consisted of 299 patients with IBD, median age 34.15, 63% females, 70.9% had Crohn's disease, filled the questionnaires. In the multivariate analysis, lower results in IP, SE and SOC were found to be associated with significantly increase anxiety (OR 8.35, p<0.001; OR 4.18, p=0.001; OR 4.67, p<0.001, respectively) and depression (OR 15.8, p=0.001; OR 10.99, p=0.029; OR 6.12, p=0.014.

CONCLUSIONS

Anxiety and depression are associated with IP, SE and SOC in patients with IBD. Clinicians should be aware of this impact, recognise their patients' psychological abilities to cope with the disease and improve those abilities, when needed, in order to achieve a better coping with the disease and to prevent the development of anxiety and depression.

The effect of Benson relaxation method on anxiety in the emergency care

OBJECTIVE

To analyze clinical and sociodemographic properties of the patients as measured by the "Hospital Anxiety and Depression Scale-HADS" including the subscale regarding anxiety (HAD-A) in emergency department (ED) and to detect the effect of a session of Benson relaxation method (BRM) on high anxiety level.

METHODS

Adult patients presented to the state hospital ED in seven days were recruited in this prospective study. Patients with high (≥8) scores were randomized to the treatment or control groups. They were asked to pursue BRM to alleviate anxiety.

RESULTS

Six hundred thirty-four patients were recruited (mean age 44.1 and 52% were female). Patients with acute exacerbation or with psychiatric illness, with a systemic disease and higher acuity level had higher HAD-A scores (P < .05). BRM group had a mean score change higher than controls (7.2 ± 2.9 vs 3.4 ± 2.6, t test, P = .026).

CONCLUSIONS

Patients who underwent BRM had larger decreases in HAD-A scores than others.

The effect of Xinkeshu tablets on depression and anxiety symptoms in patients with coronary artery disease: Results from a double-blind, randomized, placebo-controlled study

A large proportion of patients with coronary artery disease (CAD) suffer from depression or anxiety symptoms and this is associated with increased mortality [1]. This double-blinded, randomized, placebo-controlled, clinical trial (ChiCTR-IPR-17010940) aimed to explore whether Xinkeshu tablets can reduce anxiety or depressive symptoms in CAD patients and how this is related to the concentration of plasma cytokines. Sixty patients with CAD anda Hospital Anxiety and Depression Scale (HADS-a/HADS-d) score of ≥8 were treated with Xinkeshu tablets or placebo for 12 weeks following percutaneous revascularization. Depressive/anxiety symptoms and the levels of 440 peripheral blood cytokines were evaluated at baseline and after 12 weeks treatment. Results showed significantly lower (P < 0.05) HADS-a/HADS-d and PHQ-9 scores in CAD patients treated with Xinkeshu tablets than in those who received placebo. These improvements were associated with changes in certain peripheral blood cytokines; most notably trappin-2, adiponectin, interleukin 1β (IL-1β), thrombopoietin, activated leukocyte cell adhesion molecule (ALCAM), neurotrophin-3 (NT-3), and transferrin. A significant correlation between anxiety/depression symptoms and trappin-2, NT-3, transferrin, and ALCAM (p < 0.05) were observed in an independent cohort of patients with CAD. These findings were in-keeping with the anti-depressive effects of Xinkeshu tablets. This trial demonstrates that Xinkeshu tablets can improve anxiety and depression symtoms effectively address in patients with coronary heart disease possibly through increasing the blood ratio of anti-inflammatory:pro-inflammatory cytokines.

Analysis of Anxiety, Depression and Aggression in Patients Attending Pain Clinics

The aim of the study was to measure the frequency of such emotional disturbances as anxiety, depression and aggression among patients treated in a pain clinic, as well as assess the factors contributing to such disorders. Research was conducted from January 2014 to April 2018 and involved patients treated in two pain clinics in the city of Warsaw, Poland. The study used the Hospital Anxiety and Depression Scale-Modified Version (HADS-M) and the Numerical Rating Scale (NSR). 1025 patients were recruited. The main reasons for their attending the pain clinic were osteoarticular pain (43.61%) and neuropathic pain (41.56%). Emotional disturbances in the form of anxiety were diagnosed in 32.39% of all the patients, depression in 17.85%, and aggression in 46.15%. The factors determining the level of anxiety in the study group were: sex, age, pain intensity and the lack of pharmacological treatment. Depression was determined by sex, pain intensity and the time of treatment in the clinic, while aggression by age and pain intensity.

Emergency department patients' clinical and demographic characteristics regarding Hospital Anxiety subscale

OBJECTIVE

To evaluate clinical and demographic characteristics of the emergency department (ED) patients using Hospital Anxiety and Depression Scale (HADS) which includes anxiety (HAD-A) subscale.

MATERIALS AND METHODS

In this cross-sectional study, all consecutive adult patients admitted to the community hospital-based ED in the study period were enrolled prospectively. HAD-A items were responded by the patients themselves. Demographic characteristics, history, and clinical findings were analyzed.

RESULTS

Four hundred and ninety-eight consecutive ED patients with eligible conditions were enrolled. Mean age was 44.1 ± 16.5 (range 18-90) and 53.0% (n = 264) were female. The presence of pathological examination finding was significantly associated with a tendency to have a HAD-A score higher than 10 (p = .044). Presence of systemic disease was significantly associated with higher anxiety scores (t-test, p = .029). Patients presented with acute exacerbation of a chronic illness and those with psychological condition had significantly higher HAD-A scores (p = .014 and p = .008, respectively).

CONCLUSIONS

High acuity, presence of pathological finding, higher income, presence of a systemic disease, acute exacerbation of a chronic illness were significantly associated with higher anxiety scores.

Burden of Non-cardiac Patients on the Emergency Room of a Rural Cardiac Center in Sindh, Pakistan

Introduction The number of cardiac patients increases on a daily basis, and emergency departments bear much of the burden of non-cardiac patients due to pathological fears of the aftermath of the disease. Therefore, this study aimed to determine the burden of non-cardiac patients on the emergency department of a cardiac center in a rural area of Sindh, Pakistan. Methods This cross-sectional study was conducted at the emergency department of Chandka Medical College Hospital in Larkana. Consecutive patients who presented with cardiac symptoms with no previous history of cardiac disease were included. After a brief history, physical examination, electrocardiogram, and a cardiac enzyme assessment, patients were categorized as cardiac or non-cardiac. Data were analyzed using IBM SPSS Statistics for Windows, Version 21.0. (IBM Corp., Armonk, NY, US) and p ≤0.05 was statistically significant. Results Of the 204 patients included, 112 (59.8%) were men, and the mean age was 47 ± 16 years. Most patients (n = 146; 71.6%) were diagnosed as non-cardiac. The non-cardiac diagnosis was significantly more common among patients without diabetes (n = 123, 77.4% vs. n = 23, 51.1%; p = 0.001), without chest pains (n = 93, 81.6% vs. n = 53, 58.9%; p< 0.001), and without shortness of breath (n = 107, 75.9% vs. n = 39, 61.9%; p = 0.041). Conclusion More than two-thirds of the patients were found to have a non-cardiac mechanism behind their symptoms. A major proportion of the emergency room's cardiology department is occupied by non-cardiac patients. Owing to its direct and indirect implication on an otherwise struggling health system, we suggest chest pain units should be developed to decrease the workload and provide better care to cardiac patients.

Revealing the Puzzle of Nonadherence in IBD-Assembling the Pieces

BACKGROUND

Adherence is generally associated with improved treatment outcomes in inflammatory bowel disease (IBD) patients. Different components of the patient profile have an impact on patient adherence. Capturing nonadherent patients by identifying modifiable risk factors in daily practice still remains a challenge. The objective of this study was to identify modifiable and nonmodifiable risk factors for nonadherence in IBD patients.

METHODS

Patients filled out questionnaires including demographic, clinical, and socioeconomic information and accessibility to gastrointestinal services. Psychological features were assessed using the Sense of Coherence, Hospital Anxiety and Depression Scale, IBD-Self Efficacy, and Brief Illness Perception (BIPQ) questionnaires. Adherence to treatment was evaluated using the Morisky score.

RESULTS

The study included 311 patients: 62.4% females, median age 34.78 years, 70.4% Crohn's disease (CD). Multivariate analysis was done in 3 sections: demographic and disease characteristics, communication with medical staff, and psychological aspects; all included sex and disease type. Ulcerative colitis (UC) patients were less adherent (odds ratio [OR], 1.792; OR, 1.915; OR, 1.748; respectively). Females were less adherent in 2 sections (OR, 1.841; OR, 1.751; respectively). Employment (OR, 2.449), low score in on the BIPQ-understanding of disease (OR, 0.881), and poor communication with the gastroenterologist (OR, 1.798) were also predictors of low adherence.

CONCLUSIONS

Nonmodifiable characteristics such as female sex and UC are associated with low adherence. Good communication with the treating physician and understanding the disease are modifiable factors associated with high adherence. Early intervention might improve patients' adherence.

Effects of Aerobic Exercise on Anxiety Symptoms and Cortical Activity in Patients with Panic Disorder: A Pilot Study

BACKGROUND

The effects of the aerobic exercise on anxiety symptoms in patients with Panic Disorder (PD) remain unclear. Thus, the investigation of possible changes in EEG frontal asymmetry could contribute to understand the relationship among exercise, brain and anxiety.

OBJECTIVE

To investigate the acute effects of aerobic exercise on the symptoms of anxiety and the chronic effects of aerobic exercise on severity and symptoms related to PD, besides the changes in EEG frontal asymmetry.

METHODS

Ten PD patients were divided into two groups, Exercise Group (EG; n=5) and Control Group (CG; n=5), in a randomized allocation. At baseline and post-intervention, they submitted the psychological evaluation through Panic Disorder Severity Scale (PDSS), Beck Anxiety Inventory (BAI), Beck Depression Inventory-II (BDI-II), EEG frontal asymmetry, and maximal oxygen consumption (VO2max). On the second visit, the patients of EG being submitted to the aerobic exercise (treadmill, 25 minutes, and 50-55% of heart rate reserve) and the CG remained seated for the same period of time. Both groups submitted a psychological evaluation with Subjective Units of Distress Scale (SUDS) at baseline, immediately after (Post-0), and after 10 minutes of the rest pause (Post-10). The patients performed 12 sessions of aerobic exercise with 48-72 hours of interval between sessions.

RESULTS

In EG, SUDS increased immediately after exercise practice and showed chronic decrease in BAI and BDI-II as well as increased in VO2max (Post-intervention).

CONCLUSION

Aerobic exercise can promote increase in anxiety acutely and regular aerobic exercise promotes reduction in anxiety levels.

Irritable bowel syndrome among nurses working in King Abdulaziz University Hospital, Jeddah, Saudi Arabia

BACKGROUND

Irritable bowel syndrome (IBS) is a highly prevalent gastrointestinal disorder that can cause disability and economic burden. Nurses are a vital part of the medical team and their well-being is an important issue. Yet, few studies have been done concerning IBS among nurses.

OBJECTIVES

To determine the prevalence, severity, and predictors of IBS among nurses working at King Abdulaziz University Hospital, Jeddah, Saudi Arabia.

MATERIALS AND METHODS

A cross-sectional study was conducted among 229 nurses who fulfilled the eligibility criteria. They were selected by stratified random sampling during 2014-2015. A validated, confidential, self-administered data collection sheet was used for collection of personal and sociodemographic data. Rome III Criteria, IBS Severity Scoring System (IBS-SSS), Hospital Anxiety and Depression Scale (HADS), and Pittsburgh Sleep Quality Index (PSQI) were included. Both descriptive and inferential statistics were done. A multiple logistic regression analysis was done to determine the predictors of IBS.

RESULTS

The prevalence of IBS among nurses was 14.4%, and IBS-Mixed type was the commonest variety (54.5%). Positive family history of IBS, working in outpatient clinics, having day shift, poor sleep quality, and high anxiety and depression scale scores were significantly associated with IBS. After controlling for confounding factors in regression analysis, the predictors of IBS were food hypersensitivity (aOR=4.52; 95% CI: 1.80-11.33), morbid anxiety (aOR=4.34; 95% CI: 1.49-12.67), and positive family history of IBS (aOR=3.38; 95% CI: 1.12-13.23).

CONCLUSION

The prevalence of IBS was 14.4%. Food hypersensitivity, morbid anxiety, and family history were the predictors of IBS. Screening and management of IBS, food hypersensitivity, and psychological problems among nurses are recommended.

Shared Genetic Factors of Anxiety and Depression Symptoms in a Brazilian Family-Based Cohort, the Baependi Heart Study

To investigate the phenotypic and genetic overlap between anxiety and depression symptoms in an admixed population from extended family pedigrees. Participants (n = 1,375) were recruited from a cohort of 93 families (mean age±SD 42±16.3, 57% female) in the rural town of Baependi, Brazil. The Hospital Anxiety and Depression Scale (HADS) was used to assess depression and anxiety symptoms. Heritability estimates were obtained by an adjusted variance component model. Bivariate analyses were performed to obtain the partition of the covariance of anxiety and depression into genetic and environmental components, and to calculate the genetic contribution modulating both sets of symptoms. Anxiety and depression scores were 7.49±4.01 and 5.70±3.82, respectively. Mean scores were affected by age and were significantly higher in women. Heritability for depression and anxiety, corrected for age and sex, were 0.30 and 0.32, respectively. Significant genetic correlations (ρ_g = 0.81) were found between anxiety and depression scores; thus, nearly 66% of the total genetic variance in one set of symptoms was shared with the other set. Our results provided strong evidence for a genetic overlap between anxiety and depression symptoms, which has relevance for our understanding of the biological basis of these constructs and could be exploited in genome-wide association studies.

Reliability and validity of the Hospital Anxiety and Depression Scale in an emergency department in Saudi Arabia: a cross-sectional observational study

BACKGROUND

Depression and anxiety are prevalent psychiatric comorbidities that are known to have a negative impact on a patient's general prognosis. But screening for these potential comorbidities in a hospital's accident and emergency department has seldom been undertaken, particularly in Saudi Arabia and elsewhere in the Middle East. The Hospital Anxiety and Depression Scale (HADS) has been extensively used to evaluate these psychiatric comorbidities in various clinical settings at all levels of health care services except for the accident and emergency department. This study therefore aimed to assess the reliability and validity of the HADS for anxiety and depression among patients at a hospital accident and emergency department in Saudi Arabia.

METHODS

This cross-sectional observational study was conducted from January to December 2012. The participants were 257 adult patients (aged 16 years and above) who presented at the accident and emergency department of King Khalid University Hospital, Riyadh, Saudi Arabia, who met our inclusion criteria. We used an Arabic translation of the HADS. We employed factor analysis to determine the underlying factor structure of that instrument in assessing reliability and validity.

RESULTS

We found the Arabic version of the HADS to be acceptable for 95% of the subjects. We used Cronbach's alpha coefficient to evaluate reliability, and it indicated a significant correlation with both the anxiety (0.73) and depression (0.77) subscales of the HADS, thereby supporting the validity of the instrument. By means of factor analysis, we obtained a two-factor solution according to the two HADS subscales (anxiety and depression), and we observed a statistically significant correlation (r = 0.57; p < 0.0001) between the two subscales.

CONCLUSION

The HADS can be used effectively in an accident and emergency department as an initial screening instrument for anxiety and depression. It thus has great potential as part of integrated multidisciplinary care.

Difficult colonoscopy score identifies the difficult patients undergoing unsedated colonoscopy

Background

Many factors have been found to affect the difficulty of colonoscope insertion, such as age, gender, body mass index (BMI), history of abdominal surgery and operator etc. However, a scoring system may be more useful to predict the difficulty during colonoscopy.

Methods

The individual and procedure-related data of 616 patients undergoing colonoscopy were prospectively collected from December 2013 through February 2014 in Xijing Hospital of Digestive Diseases. Cox regression analysis was used to identify high-risk factors associated with difficulty of colonoscopy. A predicting model with the difficult colonoscopy score (DCS) was developed.

Results

Total cecum intubation rate was 98.9% (609/616). Advanced age, lower BMI, inexperienced operator and fair or poor sleep quality were identified as independent factors of prolonged insertion time (all p < 0.05), which were used to develop the DCS. Based on the score, patients could be divided into high-risk and low-risk groups with distinct incomplete rates within 10 min (42.0% vs. 16.5%, p < 0.001). Compared with those with DCS ≤ 1, patients with DCS > 1 had increased insertion time (10.6 ± 0.7 min vs. 6.9 ± 0.2 min, p < 0.001) and pain score (1.9 ± 1.5 vs. 1.4 ± 1.4, p = 0.002). More abdominal compression (36.9% vs. 16.8%, p < 0.001) and position change (51.4% vs. 22.6%, p < 0.001) were needed in this group of patients.

Conclusion

Patients with DCS > 1 had longer insertion time, higher pain score and needed more abdominal compression and position changes. DCS was useful for predicting the difficulty of colonoscope intubation.

(ClinicalTrials.gov NCT02105025 05/05/2014).

Electronic supplementary material

The online version of this article (doi:10.1186/s12876-015-0273-7) contains supplementary material, which is available to authorized users.

Myocardial perfusion imaging study of CO(2)-induced panic attack

Chest pain is often seen alongside with panic attacks. Moreover, panic disorder has been suggested as a risk factor for cardiovascular disease and even a trigger for acute coronary syndrome. Patients with coronary artery disease may have myocardial ischemia in response to mental stress, in which panic attack is a strong component, by an increase in coronary vasomotor tone or sympathetic hyperactivity setting off an increase in myocardial oxygen consumption. Indeed, coronary artery spasm was presumed to be present in cases of cardiac ischemia linked to panic disorder. These findings correlating panic disorder with coronary artery disease lead us to raise questions about the favorable prognosis of chest pain in panic attack. To investigate whether myocardial ischemia is the genesis of chest pain in panic attacks, we developed a myocardial perfusion study through research by myocardial scintigraphy in patients with panic attacks induced in the laboratory by inhalation of 35% carbon dioxide. In conclusion, from the data obtained, some hypotheses are discussed from the viewpoint of endothelial dysfunction and microvascular disease present in mental stress response.

Brazilian Portuguese validated version of the Cardiac Anxiety Questionnaire

Background

Cardiac Anxiety (CA) is the fear of cardiac sensations, characterized by recurrent anxiety symptoms, in patients with or without cardiovascular disease. The Cardiac Anxiety Questionnaire (CAQ) is a tool to assess CA, already adapted but not validated to Portuguese.

Objective

This paper presents the three phases of the validation studies of the Brazilian CAQ.

Methods

To extract the factor structure and assess the reliability of the CAQ (phase 1), 98 patients with coronary artery disease were recruited. The aim of phase 2 was to explore the convergent and divergent validity. Fifty-six patients completed the CAQ, along with the Body Sensations Questionnaire (BSQ) and the Social Phobia Inventory (SPIN). To determine the discriminative validity (phase 3), we compared the CAQ scores of two subgroups formed with patients from phase 1 (n = 98), according to the diagnoses of panic disorder and agoraphobia, obtained with the MINI - Mini International Neuropsychiatric Interview.

Results

A 2-factor solution was the most interpretable (46.4% of the variance). Subscales were named "Fear and Hypervigilance" (n = 9; alpha = 0.88), and "Avoidance", (n = 5; alpha = 0.82). Significant correlation was found between factor 1 and the BSQ total score (p < 0.01), but not with factor 2. SPIN factors showed significant correlations with CAQ subscales (p < 0.01). In phase 3, "Cardiac with panic" patients scored significantly higher in CAQ factor 1 (t = -3.42; p < 0.01, CI = -1.02 to -0.27), and higher, but not significantly different, in factor 2 (t = -1.98; p = 0.51, CI = -0.87 to 0.00).

Conclusions

These results provide a definite Brazilian validated version of the CAQ, adequate to clinical and research settings.

Panic attack triggering myocardial ischemia documented by myocardial perfusion imaging study. A case report

BACKGROUND

Chest pain, a key element in the investigation of coronary artery disease is often regarded as a benign prognosis when present in panic attacks. However, panic disorder has been suggested as an independent risk factor for long-term prognosis of cardiovascular diseases and a trigger of acute myocardial infarction.

OBJECTIVE

Faced with the extreme importance in differentiate from ischemic to non-ischemic chest pain, we report a case of panic attack induced by inhalation of 35% carbon dioxide triggering myocardial ischemia, documented by myocardial perfusion imaging study.

DISCUSSION

Panic attack is undoubtedly a strong component of mental stress. Patients with coronary artery disease may present myocardial ischemia in mental stress response by two ways: an increase in coronary vasomotor tone or a sympathetic hyperactivity leading to a rise in myocardial oxygen consumption. Coronary artery spasm was presumed to be present in cases of cardiac ischemia linked to panic disorder. Possibly the carbon dioxide challenge test could trigger myocardial ischemia by the same mechanisms.

CONCLUSION

The use of mental stress has been suggested as an alternative method for myocardial ischemia investigation. Based on translational medicine objectives the use of CO2 challenge followed by Sestamibi SPECT could be a useful method to allow improved application of research-based knowledge to the medical field, specifically at the interface of PD and cardiovascular disease.

Depressive symptoms and healthcare utilization in patients with noncardiac chest pain compared to patients with ischemic heart disease

OBJECTIVES

We compared depressive symptoms and healthcare utilization in patients admitted for noncardiac chest pain, acute myocardial infarction, and angina pectoris after hospitalization and at 1-year follow-up.

METHODS

One hundred and thirty-one patients with noncardiac chest pain, 66 with acute myocardial infarction, and 70 with angina pectoris completed a depression screening questionnaire and the Montgomery Åsberg Depression Rating Scale. Healthcare utilization data were collected from a population-based, diagnosis-related database.

RESULTS

More than 25% of respondents reported depressive symptoms, regardless of diagnosis. At follow-up, 9% had recovered, 19% were still experiencing depressive symptoms, and 13% had developed depressive symptoms. Noncardiac patients with chest pain had similar primary care contacts, but fewer hospital admissions, than patients with an acute myocardial infarction. Patients with angina pectoris and depressive symptoms used the most healthcare services.

CONCLUSIONS

Depressive symptoms were common. Patients with noncardiac chest pain used as much primary care as did patients with an acute myocardial infarction. Interventions should focus on identifying and treating depressive symptoms.

Anxiety, panic disorder and coronary artery disease: issues concerning physical exercise and cognitive behavioral therapy

Psychological factors such as stress and depression have already been established as primary and secondary cardiovascular risk factors. More recently, the role of anxiety in increasing cardiac risk has also been studied. The underlying mechanisms of increased cardiac risk in panic disorder patients seem to reflect the direct and indirect effects of autonomic dysfunction, as well as behavioral risk factors associated with an unhealthy lifestyle. Implications of the comorbidity between panic and cardiovascular disease include higher morbidity, functional deficits, increased cardiovascular risk, and poor adherence to cardiac rehabilitation or exercise programs. This article probes the most recent evidence on the association between coronary artery disease, anxiety and panic disorder, and discusses the potential role of incorporating regular physical exercise and cognitive behavioral therapy in the treatment of this condition.