Some Heart Symptoms May Not Have Physical Causes

Anxiety and hypochondria were higher in patients with cardiac symptoms but normal coronary arteries

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Chest pain is always a good reason to see the doctor. But, in some cases, heart symptoms like chest pains may not have a physical cause.

Doctors sometimes find normal coronary arteries (blood vessels that supply blood to the heart) in patients who have chest pains. A German research team recently set out to study what else could be causing chest pains in a group of these patients.

The researchers found that these patients had more anxiety than the general population. These patients also were more likely to have hypochondria — anxiety about their health — and physical pain that was related to psychological factors, not to a physical cause.

"When an individual is anxious, the nature of their anxiety will produce tense muscles and ruminating concerns in regards to their general health," Daniel Berarducci, MA, CPC, of Person-Holistic Innovations in Las Vegas, NV, told dailyRx News.

"Within the symptomology of panic attacks, concerns such as tightness in the chest, shortness of breath or being unable to breath, and thoughts that they are having a heart attack will also mirror chest related concerns that the individual may have experienced prior to having a 'clean bill of health' with their heart related issues," said Berarducci, who was not involved in this study.

The lead study author was Marian Christoph, MD, from the University of Dresden in Germany.

About 1 in 5 patients with chest pain, shortness of breath or a racing heart beat does not test positive for coronary artery disease, the study authors noted. And psychological disorders like depression and anxiety may cause symptoms similar to those caused by heart problems.

To assess mental symptoms in 253 patients who had heart symptoms without heart disease, the study authors used a series of surveys. The surveys asked the patients about their levels of anxiety, hypochondria, depression and feelings of physical pain without a physical cause.

The patients were also asked about their heart symptoms before and after their coronary angiography — a test that uses dye and X-rays to look for coronary artery problems. This test can allow doctors to see whether plaque has built up in or blocked any blood vessels, which can lead to coronary artery disease.

The study authors found that 70 percent of the patients who had a normal angiography test still felt chest pain. They also found anxiety in 37 percent more women and 22 percent more men in this study than in the general population.

Anxiety that centered on heart concerns was 27 percent higher in these patients than in the general population. And hypochondria was 68 percent more common in these patients than in the average person.

The study authors said that this study may provide tools to diagnose mental symptoms and causes of chest pain in patients who do not have heart problems.

"Patients with non-cardiac chest pain should be examined early on for [mental disorders]," the study authors wrote.

According to Berarducci, "With individuals who may be susceptible to anxiety prior to their health concerns, concurrent and post-treatment therapy (primarily Cognitive-Behavioral Therapy) would be of benefit in order to assist the individual in understanding how their ruminating thoughts and panic-related symptoms could affect their physical and mental health."

Tests to detect psychological reasons for chest pain could prevent unnecessary use of the health care system and allow for early therapy, the study authors explained.

The study authors noted that patients did not undergo full psychiatric evaluations. They also said that some of the patients could have had heart disease that the tests used in the study did not detect.

The research was published online Nov. 3 in Open Heart.

The authors disclosed no funding sources or conflicts of interest.

Review Date: 
November 5, 2014
Last Updated:
November 10, 2014