Beitman B D, Mukerji V, Lamberti J W, Schmid L, DeRosear L, Kushner M, Flaker G, Basha I
Department of Psychiatry, University of Missouri-Columbia.
Am J Cardiol. 1989 Jun 1;63(18):1399-403. doi: 10.1016/0002-9149(89)91056-4.
Although patients with angiographically normal or near normal coronary arteries are at low risk for cardiac disease, several follow-up studies have shown that many continue to report recurrent chest pain associated with social and work dysfunction. Three diagnostic entities have been proposed to explain the morbidity of this group: microvascular angina, esophageal motility disorders and panic disorder. The purpose of this study was to test the hypothesis that panic disorder is found frequently in patients with chest pain who have normal epicardial vessels. Ninety-four subjects with angiographically normal coronary arteries were interviewed according to a structured psychiatric protocol within 24 hours of their catheterizations. Thirty-two (34%) fit Diagnostic and Statistical Manual of Mental Disorders (third edition, revised) criteria for current panic disorder. Because panic disorder can be effectively treated, physicians should consider this diagnosis in this group of patients. Current research findings suggest that panic disorder, microvascular angina and esophageal disorders may each form the basis for chest pain in approximately 25% of these patients. Miscellaneous problems account for the other 25%.
尽管冠状动脉造影显示正常或接近正常的患者患心脏病的风险较低，但多项随访研究表明，许多患者仍持续报告反复出现胸痛，并伴有社交和工作功能障碍。已提出三种诊断实体来解释该组患者的发病情况：微血管性心绞痛、食管运动障碍和惊恐障碍。本研究的目的是检验以下假设：在具有正常心外膜血管的胸痛患者中，惊恐障碍很常见。94例冠状动脉造影正常的受试者在导管插入术后24小时内按照结构化精神病学方案接受了访谈。32例（34%）符合《精神疾病诊断与统计手册》（第三版，修订版）中当前惊恐障碍的标准。由于惊恐障碍可以得到有效治疗，医生应该在这组患者中考虑这一诊断。目前的研究结果表明，惊恐障碍、微血管性心绞痛和食管疾病可能各自构成这些患者中约25%的胸痛基础。其他25%由各种杂项问题导致。
