Psychiatric morbidity and the presence and absence of angiographic coronary disease in patients with chest pain.

OBJECTIVE: To assess psychiatric morbidity in coronary angiogram patients. METHOD: A psychiatric assessment of 200 consecutive chest-pain patients was performed the day before coronary angiography in a double-blind study design. The sample included 132 men (mean age 57.2 years, SD 9.5) and 68 women (mean age 59.8 years, SD 8.9). A Structured Clinical Interview for DSM-III-R was used to obtain psychiatric diagnosis. The 21-item Beck Depression Inventory, the 20-item Toronto Alexithymia Scale and a four-item Life Satisfaction Scale were used to assess mental symptoms. A coronary angiography with obstruction of a coronary artery by more than 50% was considered to indicate angiographic coronary disease. RESULTS: Mental disorders were found in 28% (95% CI 14-41) of the patients with normal angiographic findings (n=47) and in 24% (95% CI 17 - 30) of the patients with angiographic coronary disease (n=153). Furthermore, no difference was found between these two groups in other rating scales assessing mental symptoms even when adjusted for the New York Heart Association class, duration of chest-pain symptoms or exercise capacity. CONCLUSION: Psychiatric morbidity may not be associated with angiographic findings in patients with chest pain.

[Characteristics of mental status of patients with neurocirculatory dystonia]. / Osobennosti psikhicheskogo statusa bol'nykh s neirotsirkuliatornoi distoniei.

AIM: To specify forms of severity of mental disorders in neurocirculatory asthenia (NCA) for more precise differentiation between NCA as a nosological entity and syndrome. MATERIAL AND METHODS: The examination including specially-designed interview, ECG, echo-CG, orthostatic and hyperventilation tests, bicycle exercise, consultation of the psychiatrist, psychological tests covered 80 NCA patients (31 men, 49 women, mean age 29.2 +/- 9.08 years). RESULTS: NCA is characterized by the absence of a clear link with psychoemotional stress, seasonal disease aggravations, weakness, dizziness, negative results of orthostatic and hyperventilation tests. Among NCA criteria, dominating are "additional signs". Patients with anxio-fobic, panic, anxio-depressive neurotic disorders are characterized by strong relations between manifestation, subsequent disease exacerbations with psychogenia; attack-like NCA manifestation, prevalence of "basic signs" among diagnostic criteria (cardialgia, pulse and blood pressure lability, nonspecific alterations of T wave, positive orthostatic and hyperventilation tests). CONCLUSION: NCA presents at least with two variants. In the first variant NCA picture is characterized by hereditary or early acquired vegetative stigmation and secondary neurotic disorders; the second variant presents as a clinically formed illness in which NCA symptoms manifest as a syndrome which is a leading component of a mental disease.

[Comparison of the hemodynamic effects of Corinfar in patients with neurocirculatory dystonia and hypertensive disease]. / Sravnitel'noe vliianie korinfara na gemodinamiku u bol'nykh neirotsirkuliatornoi distoniei i gipertonicheskoi bolezn'iu.

Echocardiography was used to study the cardio- and hemodynamic effects of corinfar in 22 patients with neurocirculatory dystonia and 24 with hypertensive disease. The agent showed a pronounced hyperdynamic effect in patients with neurocirculatory dystonia, whereas it significantly lowered systolic, diastolic, mean blood pressures in those with hypertensive disease, by facilitating left ventricular performance without hyperkinemia. It is concluded that neurocirculatory dystonia and hypertensive disease are different diseases, by judging from the cardio- and hemodynamic effects of the calcium antagonist in these patients.

[Left ventricular systolic function in young women with hyperkinetic syndrome--echocardiographic evaluation]. / Czynnosc skurczowa lewej komory serca u mlodych kobiet z zespolem samoistnego krazenia hiperkinetycznego--ocena echokardiograficzna.

In twenty two young (mean age 31.6 years) normotensive women with hyperkinetic heart syndrome (HHS) we assessed echocardiographically left ventricular (LV) function indexes before and after 40 mg of oral propranolol. At baseline the HHS group differed from controls with respect to higher heart rate heart and diastolic blood pressure (BPs), lower systolic and systolic LV volumes, greater corrected mean circumferential fiber shortening, ejection fraction, cardiac index and contractility index (systolic blood pressure x body surface area/LV end-systolic volume ratio). Propranolol normalized nearly all analyzed indexes except for BPs which remained increased compared to controls. In young women with HHS enhanced cardiac performance is expressed by higher cardiac index and speed of blood ejection from the left ventricle, is related to tachycardia and higher contractility but not to increased preload. Results post propranolol administration speak in favour of significant role of increased beta-adrenoceptor stimulation in HHS.

Major depression and agoraphobia in patients with angiographically normal coronary arteries and panic disorder.

Patients with panic disorder and/or agoraphobia appearing in psychiatric settings report rates for lifetime major depression between 24% and 91%. Between 40% and 90% of patients with panic disorder in psychiatric populations report concomitant agoraphobia. A recent study of panic disorder subjects appearing in an outpatient cardiology clinic confirmed the strong link between panic and depression but found only a weak association between panic disorder and agoraphobia. In order to test the reliability of these outpatient cardiology findings, the authors studied major depression and agoraphobia in patients with angiographically normal coronary arteries and panic disorder. Twelve of the 32 (37.5%) panic disorder subjects reported a lifetime history of major depression (nine current, three past only). Only two of the 32 (six percent) reported any phobic avoidance. This study confirms the previous findings which suggest that major depression is common in cardiology populations with panic disorder and that phobic avoidance is uncommon in this group.