Unexplained Breathlessness and Psychiatric Morbidity in Patients With Normal and Abnormal Coronary Arteries

Bass, Christopher; Wade, Clyde; Gardner, W. N.; Cawley, R. H.; Ryan, Kimberley; Hutchison, D. C. S.; Jackson, Graham

doi:10.1016/s0140-6736(83)91791-9

Cited by 81 publications

(13 citation statements)

References 24 publications

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“…Camici are a female preponderance; chest pain that is 'atypical' insofar as provocation by exercise is not a reliable feature, with rest pain quite common; poor correlation with metabolic and haemodynamic evidence of ischaemia; inconsistency of relationship to the exercise ECG; and generally an unsatisfactory response to conventional anti-anginal drugs. The prognosis of this group of patients is, however, extremely good (Proudfit et al 1980;Bass et al 1983;Papanicolaou et al 1986), except for those presenting with left bundle branch block on the ECG (Kemp et al 1986;Opherk et al 1989). Histological investigations (e.g.…”

Section: Clinical Featuresmentioning

confidence: 87%

“…Clinical features (Dwyer et al 1969;Neill et al 1972;Bass et al 1983) that tend to distinguish the syndrome X patient from the patient with coronary artery disease Offprint requests to: P.G. Camici are a female preponderance; chest pain that is 'atypical' insofar as provocation by exercise is not a reliable feature, with rest pain quite common; poor correlation with metabolic and haemodynamic evidence of ischaemia; inconsistency of relationship to the exercise ECG; and generally an unsatisfactory response to conventional anti-anginal drugs.…”

Section: Clinical Featuresmentioning

confidence: 99%

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Syndrome X: radionuclide studies of myocardial perfusion in patients with chest pain and normal coronary arteriograms

Rosen

Camici

1992

Eur J Nucl Med

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Section: Clinical Featuresmentioning

confidence: 87%

Section: Clinical Featuresmentioning

confidence: 99%

Syndrome X: radionuclide studies of myocardial perfusion in patients with chest pain and normal coronary arteriograms

Rosen

Camici

1992

Eur J Nucl Med

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“…Respiratory changes, including the "hyperventilation syndrome," are associated with anxiety (Jones & Mellersh, 1946;Coppen & Mezey;1960, Goldstein, 1964Lum, 1975;Missri & Alexander, 1978;CompernoUe et al, 1979;Magarian, 1982;Pincus & Tucker, 1985;Bass et al, 1983;Bass & Gardner, 1985;Clark, 1986). Patients tend to breathe faster and less efficiently than normal subjects.…”

Section: Autonomic and Cardiovascular Changesmentioning

confidence: 99%

Systemic hormonal and physiological abnormalities in anxiety disorders

Cameron

Nesse

1988

Psychoneuroendocrinology

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Among the studies of systemic hormonal and physiological abnormalities associated with anxiety disorders, the most consistent and extensive findings suggest (a) peripheral adrenergic hyperactivity (including increases in norepinephrine but not epinephrine) and functional dysregulation, (b) increased incidence of mitral valve prolapse in panic patients, and (c) normal suppressibility of the hypothalamic-pituitary-adrenal cortical endocrine system with dexamethasone in panic patients. Other less-certain findings include (a) increased circulating concentrations of plasma ACTH and/or cortisol, and prolactin, in panic patients, (b) increased platelet monoamine oxidase activity in generalized anxiety and/or panic patients, (c) decreased gonadal axis activity in some anxious individuals, (d) decreased nighttime melatonin plasma concentrations in panic patients, and (e) peripheral alpha 2 and beta-adrenoreceptor down-regulation, with normal serotonin binding parameters. These findings, taken together, provide tentative support for dysfunction in adrenergic and GABAergic central nervous system mechanisms in people with anxiety disorders. Abnormal anxiety and normal stress both show evidence of adrenergic hyperactivity; however, there appear to be differences in hormonal profiles, especially the apparent lack of increase of epinephrine during panic attacks, as well as differences in the reactivity of the system, and in the "trigger" mechanisms which determine when the response occurs.

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confidence: 99%

“…Future studies on the relation between psychological factors and the extent of CHD should take account of not only sex differences but also patients without significant CHD: high rates of psychiatric morbidity in such patients confound the relation between psychological trait measures and atherosclerosis. psychological characteristics (Bass et al 1983). I n p a r t i c u l a r ; t h e y h a v e h i g h r a t e s o f psychiatric Recent studies of the relation between psycho-illness and display neurotic personality traits logical variables and clinical and angiographic (Bass & Wade, 1984).…”

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confidence: 99%

Physical and psychological correlates of severe heart disease in men

Bass

Akhras

1987

Psychol. Med.

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SynopsisSeventy eight men were assessed one month before coronary artery bypass graft surgery using standardized measures of psychiatric morbidity and personality as well as a measure of emotional expression (the CECS). All patients had at least one coronary vessel occluded by 75% or more of its diameter, and functional capacity was assessed by calculating the exercise treadmill time (in seconds) for each patient.Most of the variance in exercise treadmill time was accounted for by the following variables: young age, short duration of symptoms, and less severe angina. Only one in five men was designated a psychiatric ‘case’. The only psychological measure significantly associated with atherosclerosis was expression of fear (on the CECS). A measure of Type A behaviour (Bortner score) was related to exercise treadmill time, but not to any of the angiographic or clinical indices of coronary heart disease (CHD).Like other measures of Type A behaviour, the Bortner scale is psychometrically impure and has doubtful validity. More valid behavioural variables (such as those measured by the CECS) require further investigation. Future studies on the relation between psychological factors and the extent of CHD should take account of not only sex differences but also patients without significant CHD: high rates of psychiatric morbidity in such patients confound the relation between psychological trait measures and atherosclerosis.

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Unexplained Breathlessness and Psychiatric Morbidity in Patients With Normal and Abnormal Coronary Arteries

Cited by 81 publications

References 24 publications

Syndrome X: radionuclide studies of myocardial perfusion in patients with chest pain and normal coronary arteriograms

Syndrome X: radionuclide studies of myocardial perfusion in patients with chest pain and normal coronary arteriograms

Systemic hormonal and physiological abnormalities in anxiety disorders

Physical and psychological correlates of severe heart disease in men

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