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Chest Pain Linked to Common Psychiatric Problems


WebMD Health News

Nov. 23, 1999 (Washington) -- Chest pain is a frightening -- and relatively common -- occurrence that sends millions of Americans to emergency rooms each year, where they wait for care, thinking all the while about heart attacks and maybe even death.

But heart disease is only one of several causes of chest pain, and the least common. A new study from England shows that anxiety and depression could be behind a substantial portion of the gripping pain.

Researchers asked over 3,000 36-year-old men and women about their experiences with chest pain. A relatively large percentage, 17.2%, reported having chest pain, but only 34 people had symptoms that definitely or probably were related to true heart pain.

The group was also asked about symptoms of psychiatric disorders, and those who had such symptoms were more than three times more likely to report having also had chest pain. Mathew Hotopf, MB, BS, MRCPsych, MSc, tells WebMD that about 20% of the study participants had psychiatric disorders or symptoms, with anxiety and depression equally composing the majority of disorders.

"I don't know how it is in America, I suspect it is the same as in England," says Hotopf. "But a lot of doctors here, they will see a patient [with chest pain] and they do their test[s]; and if they find nothing that can account for the chest pain, their job stops there. They are cardiologists. It's no longer their problem. But as far as the patient is concerned, it's not over. They want an answer. There is quite a lot that can be done for depression and anxiety, and it is important that they are picked up." Hotopf is a clinical senior lecturer in the Department of Psychological Medicine at King's College in London.

"For all cases of chest pain, psychiatric disorder could explain, at most, about 25% of the cases. In the case of chest pain [upon exercise], psychiatric disorder ... could explain nearly 60% of cases in the population, write the authors of the study, which appears in the November/December issue of the journal Psychosomatic Medicine.

"Particularly with anxiety, it is unclear whether it is causing the chest pain or people are more aware of the chest pain that they may already have," Hotopf tells WebMD. "It may be that having anxiety makes you more aware of the fairly innocent sensation ... a twinge in the chest."

"I see no particular shortcomings of the study; it strikes me as a fresh exposition of old information," Vincent Felitti, MD, tells WebMD. Felitti, a professor at the University of California, San Diego and head of the section of preventive medicine for Kaiser Permanente Medical Group in Southern California, reviewed the study for WebMD.

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