Chest Pain Linked to Common Psychiatric Problems

From the WebMD Archives

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.

Felitti says that the least common cause for chest pain is actually problems with the heart. Some of the pain stems from constant tightening of certain muscles, he says. "All of this goes on unconsciously. In the scalp it's a tension headache. In the back it is chronic low back pain. In the chest it is misrecognized as heart disease."

Felitti adds that the cause of chest pain isn't usually discovered if the person goes to an emergency room. "I think in the settings in which chest pain is usually seen -- typically emergency rooms -- they are not are not likely to be of a mind to look beyond anything that is of cardiac origin; they are simply diagnosing someone as not having something, instead of having something. And that sets up the likelihood of repetition," where the person will continue to have chest pain and feel the need to seek emergency care.

Vital Information:

  • A well-known symptom of a heart attack is chest pain, but heart disease is actually the least common cause of this ailment.
  • A new study shows that in up to 25% of patients, chest pain is a symptom of a psychiatric disorder, usually either anxiety or depression.
  • It is not known whether psychiatric disorders cause chest pain or whether these patients are just more aware of any sensation that they may have.