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Chest Pain with Normal Coronary Arteries: Psychological Aspects

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Chest Pain with Normal Coronary Angiograms: Pathogenesis, Diagnosis and Management

Part of the book series: Developments in Cardiovascular Medicine ((DICM,volume 213))

Abstract

Although it is only since the development of coronary angiography in the 1960’s that the label “chest pain and normal coronary arteries” has been used, accounts of similar patients can be found in the literature up to a century earlier. Most early descriptions emphasize organic abnormalities in explaining the symptoms: but there has been an increasing recognition that psychological abnormalities are also common. Several recent studies, reviewed below, have clearly demonstrated high levels of psychological morbidity, both at the time of angiography, and on follow-up. This observed association could be explained in several ways. The psychological abnormalities observed could simply be reactions to the physical symptoms; or they might cause those symptoms directly, via a range of possible pathophysiological mechanisms. A third model is suggested below, in which psychological and physical factors interact in a variety of ways to precipitate, and especially to maintain, physical symptoms. Such a model indicates a place for psychological approaches in the management of patients with chest pain and normal coronary arteries. The essential elements of a suggested form of psychological treatment are set out below, together with evidence of its efficacy.

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Authors
  1. Steve G. Potts
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  2. Christopher Bass
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Editors and Affiliations

  1. St George’s Hospital Medical School, London, UK

    Juan Carlos Kaski MD, MRCP, FACC, FESC (BHF Sugden Reader in Clinical Cardiology and Consultant Cardiologist, Head of Coronary Artery Disease Research Group) (BHF Sugden Reader in Clinical Cardiology and Consultant Cardiologist, Head of Coronary Artery Disease Research Group)

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Potts, S.G., Bass, C. (1999). Chest Pain with Normal Coronary Arteries: Psychological Aspects. In: Kaski, J.C. (eds) Chest Pain with Normal Coronary Angiograms: Pathogenesis, Diagnosis and Management. Developments in Cardiovascular Medicine, vol 213. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-5181-2_2

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  • DOI: https://doi.org/10.1007/978-1-4615-5181-2_2

  • Publisher Name: Springer, Boston, MA

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  • Online ISBN: 978-1-4615-5181-2

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