Katon W, Hall M L, Russo J, Cormier L, Hollifield M, Vitaliano P P, Beitman B D
Division of Consultation/Liaison Psychiatry, University of Washington Medical School, Seattle 98195.
Am J Med. 1988 Jan;84(1):1-9. doi: 10.1016/0002-9343(88)90001-0.
Seventy-four patients with chest pain and no prior history of organic heart disease were interviewed with a structured psychiatric interview immediately after coronary arteriography. The majority of patients with both negative and positive coronary angiographies had undergone previous exercise tolerance tests, but the patients with angiographic coronary artery disease were significantly more likely to have had positive results on a treadmill test. Patients with chest pain and negative coronary arteriograms were significantly younger; more likely to be female; more apt to have a higher number of autonomic symptoms (tachycardia, dyspnea, dizziness, and paresthesias) associated with chest pain, and more likely to describe atypical chest pain. Patients with chest pain and normal coronary arteriographic results also had significantly higher psychologic scores on indices of anxiety and depression and were significantly more likely to meet criteria of the Diagnostic and Statistical Manual of Mental Disorders, third edition, for panic disorder (43 percent versus 6.5 percent), major depression (36 percent versus 4 percent), and two or more phobias (36 percent versus 15 percent) than were patients with chest pain and a coronary arteriography study demonstrating coronary artery stenosis.
74例有胸痛且无器质性心脏病史的患者在冠状动脉造影后立即接受了结构化精神科访谈。冠状动脉造影结果为阴性和阳性的大多数患者此前都进行过运动耐量测试，但冠状动脉造影显示有冠状动脉疾病的患者在跑步机测试中更有可能得到阳性结果。有胸痛且冠状动脉造影结果为阴性的患者明显更年轻；女性比例更高；与胸痛相关的自主神经症状（心动过速、呼吸困难、头晕和感觉异常）数量更多，且更有可能描述为非典型胸痛。有胸痛且冠状动脉造影结果正常的患者在焦虑和抑郁指标上的心理评分也显著更高，并且与冠状动脉造影显示有冠状动脉狭窄的胸痛患者相比，更有可能符合《精神疾病诊断与统计手册》第三版中惊恐障碍（43%对6.5%）、重度抑郁症（36%对4%）以及两种或更多恐惧症（36%对15%）的诊断标准。
