Asamoah Kofi Tekyi, Dei-Asamoa Richard
National Cardiothoracic Centre, Korle-Bu Teaching Hospital, Accra, Ghana.
Department of Psychiatry, Korle-Bu Teaching Hospital, Accra, Ghana.
Case Rep Psychiatry. 2022 Apr 21;2022:5415196. doi: 10.1155/2022/5415196. eCollection 2022.
Cardiovascular symptoms like chest pain and palpitations are among the commonest reasons for outpatient hospital visits. Physician preoccupation with ruling out sinister cardiological diagnoses often results in a failure to recognise mental health-related disorders, which account for over 40% of such cases, especially among young women. These disorders can independently cause cardiovascular symptoms or worsen preexisting cardiovascular disease, worsening morbidity. The pathophysiology of mental stress-induced myocardial ischaemia involves increased levels of neurotransmitters, as opposed to anatomical obstruction seen in conventional coronary artery disease. This results in a battery of tests (including invasive assessments) which yield normal results, deepening the patient's psychological stress. There is therefore an increased expenditure on healthcare with little assurance of wellness. Detection of these conditions is poorer in developing countries due to limited capacity in appreciating mental health disorders, though over 70% of mental health disorders occur in these countries. Two young ladies with no comorbidities who presented with chest pain and palpitations are reported in this paper. Laboratory investigations and specific cardiology-based tests were normal, but a thorough family and social history revealed underlying mental stresses, corroborated by a mental state examination. A diagnosis of panic disorder was made and once managed, symptoms abated and quality of life improved. We seek to emphasise that mental health disorders are an important cause of cardiovascular symptoms among young adults and must be actively sought by physicians to reduce the associated morbidity, as conventional tests for ischaemia are not useful in their diagnosis. Mental state examination should be done routinely in all clinical assessments to identify patients with subtle signs and improve their clinical outcomes. There must be commitment to build capacity among nonpsychiatrists to reduce the treatment gap.
胸痛和心悸等心血管症状是门诊就诊最常见的原因之一。医生一心想着排除严重的心脏病诊断，往往导致无法识别与心理健康相关的疾病，而这类疾病在这类病例中占比超过40%，在年轻女性中尤为常见。这些疾病可独立引发心血管症状或使已有的心血管疾病恶化，增加发病率。与传统冠状动脉疾病中可见的解剖学阻塞不同，精神压力诱发心肌缺血的病理生理学涉及神经递质水平升高。这导致一系列检查（包括侵入性评估）结果正常，却加深了患者的心理压力。因此，医疗保健支出增加，但健康状况却难以保证。由于识别心理健康障碍的能力有限，发展中国家对这些疾病的检出率较低，尽管超过70%的心理健康障碍发生在这些国家。本文报告了两名无合并症但出现胸痛和心悸的年轻女性。实验室检查和基于心脏病学的特定检查结果正常，但详尽的家族史和社会史揭示了潜在的精神压力，精神状态检查也证实了这一点。诊断为惊恐障碍，一经治疗，症状缓解，生活质量改善。我们试图强调，心理健康障碍是年轻人心血管症状的一个重要原因，医生必须积极排查，以降低相关发病率，因为常规的缺血检查对其诊断并无帮助。在所有临床评估中都应常规进行精神状态检查，以识别有细微症状的患者并改善其临床结局。必须致力于培养非精神科医生的能力，以缩小治疗差距。
