Living with unexplained chest pain

Jerlock, Margaretha; Gaston‐Johansson, Fannie; Danielson, Ella

doi:10.1111/j.1365-2702.2005.01195.x

Cited by 35 publications

(75 citation statements)

References 26 publications

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“…Gastroesophageal reflux disease, esophageal motility disorders, musculoskeletal disorders, breathing disorders, depression, and anxiety are implicated as causal factors. 3,5,8 Few studies support a role of antidepressants in treating pain perception and the comorbid anxiety and depression. NCCP is considered a benign problem with various psychopathological comorbidities.…”

Section: Introductionmentioning

confidence: 99%

Noncardiac chest pain: systematic review of the literature on prognosis

Meresh¹,

Piletz²,

Halaris³

2018

RRCC

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Background: Noncardiac chest pain (NCCP) is defined as persistent angina-like chest pain with no evidence of cardiac disease. There is some controversy about the long-term morbidity and mortality outcomes of NCCP patients. Many studies have found no significant differences in death rates in chest pain patients without coronary artery disease compared to the general population. However, studies that include longer follow-up periods and a better characterization of the NCCP population reveal a twofold elevation in the relative risk of adverse cardiac events over 5-26 years. This review sought to identify studies in relation to cardiovascular and psychological prognosis of NCCP patients. Methods: PubMed database and reference lists from relevant publications were reviewed. Inclusion criteria were systematic reviews, prospective studies, and retrospective surveys from 1970 to 2011. Search terms were as follows: chest pain, noncardiac chest pain, nonspecific chest pain, unexplained chest pain, prognosis of noncardiac chest pain, prognosis of angina with normal angiography, and angina with normal coronary arteries. Results: Studies supporting worse outcome (cardiac morbidity and mortality; n=16) included 173,875 patients with mean age 57 and mean length of follow-up 7.5 years. Studies supporting good outcome (n=25) included 244,998 patients with age 50 and length of follow-up 5 years. Articles supporting poor psychological outcome (n=9) included 3,987 patients and length of follow-up 2 years. Conclusion: There are mixed data on long-term morbidity, cardiovascular adverse events, and mortality of NCCP patients. Some studies provide supporting evidence for poor outcome, while others provide evidence for positive outcome. However, many patients with NCCP have prolonged psychosocial comorbidity. The heterogeneity of NCCP and study populations limited definitive conclusions. However, many patients with NCCP have psychiatric morbidity and poor quality of life. Several questions remain about NCPP with respect to the psychopathology and pathophysiology of this condition. Whether NCCP patients have good or bad outcome requires careful risk stratification.

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Section: Introductionmentioning

confidence: 99%

Noncardiac chest pain: systematic review of the literature on prognosis

Meresh¹,

Piletz²,

Halaris³

2018

RRCC

View full text Add to dashboard Cite

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“…Patients with NCCP have been shown to experience similar levels of psychological distress (20,52) or higher levels than cardiac patients (53)(54)(55). Psychological distress includes fear, anxiety, depression, uncertainty, mental strain at work, stress, loss of strength (47,49,(54)(55)(56), as well as sleep problems and negative life events (serious illness or death of a close relative) (49,57). The uncertainty and stress could partly be due to different explanations of the chest pain by different doctors or no adequate explanation at all (47,58).…”

Section: The Impact Of Non-cardiac Chest Painmentioning

confidence: 99%

“…It can be mediated by fear due to activities that cause bodily sensations (38). NCCP patients' fear of AMI resulted in greater body awareness and avoidance of physical activity as they felt unsafe (47). Fear of body sensations is part of anxiety sensitivity and can lead to anxiety (75).…”

Section: Cardiac Anxietymentioning

confidence: 99%

“…NCCP negatively influences patients' quality of life and everyday life (35,(47)(48)(49), including interruption of daily activities and absence from work (6). Compared to other patients with chronic pain, such as AP, fibromyalgia and whiplash injury, patients with NCCP and fibromyalgia have the most impaired quality of life, particularly in the pain and mental dimensions (31).…”

Section: The Impact Of Non-cardiac Chest Painmentioning

confidence: 99%

“…As hospitals often are short-staffed and overfilled with patients, thorough investigations and follow-ups of patients with NCCP may not be a priority. These patients are often discharged without any treatment or clear explanation of the cause for their chest pain (47,58), and often fall between the cracks because they have no obvious organic causes for their chest pain. This could result in a feeling of not being taken seriously, despite continuous complaints and concerns.…”

Section: Psychological Distress Healthcare Utilization and Societal mentioning

confidence: 99%

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Improving care for patients with non-cardiac chest pain : Description of psychological distress and costs, and evaluation of an Internet-delivered intervention

Mourad¹

2015

Linköping University Medical Dissertations

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Introduction: More than half of all patients seeking care for chest pain do not have a cardiac cause for this pain. Despite recurrent episodes of chest pain, many patients are discharged without a clear explanation of the cause for their pain. A lack of explanation may result in a misinterpretation of the pain as being cardiac-related, causing worry and uncertainty, which in turn leads to substantial use of healthcare resources. Psychological distress has been associated with non-cardiac chest pain (NCCP), but there is limited research regarding the relationship between different psychological factors and their association with healthcare utilization. There is a need for interventions to support patients to manage their chest pain, decrease psychological distress, and reduce healthcare utilization and costs. Aim: The overall aim of this thesis was to improve care for patients with non-cardiac chest pain by describing related psychological distress, healthcare utilization and societal costs, and by evaluating an Internet-delivered cognitive behavioural intervention. Designs and methods: This thesis presents results from four quantitative studies. Studies I and II had a longitudinal descriptive and comparative design. The studies used the same initial cohort. Patients were consecutively approached within 2 weeks from the day of discharge from a general hospital in southeast Sweden. In study I, 267 patients participated (131 with NCCP, 66 with acute myocardial infarction (AMI), and 70 with angina pectoris (AP)). Out of these, 199 patients (99 with NCCP, 51 with AMI, 49 with AP) participated in study II. Participants were predominantly male (about 60 %) with a mean age of 67 years. Data was collected on depressive symptoms (Study I), healthcare utilization (Study I, II), and societal costs (Study II). Study III had a cross-sectional explorative and descriptive design. Data was collected consecutively on depressive symptoms, cardiac anxiety and fear of body sensations in 552 patients discharged with diagnoses of NCCP (51 % women, mean age 64 years) from four hospitals in southeast Sweden. Patients were approached within one month from the day of discharge. Study IV was a pilot randomized controlled study including nine men and six women with a median age of 66 years, who were randomly assigned to an intervention (n=7) or control group (n=8). The intervention consisted of a four-session guided Internet-delivered cognitive behavioural therapy (CBT) program containing psychoeducation, exposure to physical activity, and relaxation. The control group received usual care. Data was collected on chest pain frequency, cardiac anxiety, fear of body sensations, and depressive symptoms. Results: Depressive symptoms were prevalent in 20 % (Study IV) and 25 % (Study I, III) of the patients, and more than half of the patients still experienced depressive symptoms one year later (Study I). There were no significant differences in prevalence and severity of depressive symptoms between patients diagnosed with NCCP, AMI or AP. Living a...

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Women and non-cardiac chest pain: gender differences in symptom presentation

Carmin

Ownby

Wiegartz

et al. 2008

Arch Womens Ment Health

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SummaryA substantial number of individuals evaluated for complaints of chest pain do not suffer from coronary heart disease (CHD). Studies show that many patients who complain of symptoms that might be caused by CHD, such as shortness of breath or chest pain, may actually have an anxiety disorder. Gender differences in how patients present with these symptoms have not been adequately explored. The purpose of this study was to explore possible gender differences in the presentation of patients with CHD-like symptoms. Two groups were examined, one comprising 6,381 individuals self-referred for electron beam tomography (EBT) studies and a subset of these individuals who defined a "low-risk" group based on the absence of risk factors for CHD and low coronary artery calcium (CAC) scores. We explored gender differences in symptom presentation in each group after controlling for relevant variables by using logistic regression models.These analyses showed that women were significantly more likely than men to endorse CHD symptoms that might also be caused by an anxiety disorder. Women in the low risk group reported CHD symptoms also referable to anxiety more often than men, but unlike men did not complain primarily of chest pain. Women were also more likely to have been prescribed antianxiety or antidepressant medication. In previous studies, non-cardiac chest pain has been considered a hallmark of anxiety in individuals seen in medical settings. This study suggests that in individuals with low risk for CHD chest pain was not related to gender, but other anxiety-related symptoms including heart flutter, lightheadedness, nausea, and shortness of breath were more likely to be reported in women than in men.

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Living with unexplained chest pain

Abstract: Patients are not receiving optimal care to relieve their pain and there is therefore a need for specialized nurses who can give adequate help and support.

Cited by 35 publications

References 26 publications

Noncardiac chest pain: systematic review of the literature on prognosis

Noncardiac chest pain: systematic review of the literature on prognosis

Improving care for patients with non-cardiac chest pain : Description of psychological distress and costs, and evaluation of an Internet-delivered intervention

Women and non-cardiac chest pain: gender differences in symptom presentation

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