Psychological aspects: Diagnosis and management

Chest pain is a common presenting complaint that raises the possibility of serious medical pathology and often precipitates comprehensive medical evaluations and referrals. Since it is associated with coronary artery disease and myocardial infarction, it is perhaps understandable that chest pain is one of the most anxiety-provoking medical complaints for patients and their families. Approximately one-half of patients who undergo cardiac evaluations do not show evidence of cardiac dysfunction underlying their pain [1]. The syndrome of non-CAD chest pain is characterized by recurrent chest pain in the absence of identifiable cardiac etiology and is often accompanied by emotional distress (i.e., anxiety, depression), functional impairment, and is associated with reduced quality of life. In this chapter, we describe non-CAD chest pain from a psychological perspective and highlight the complex biopsychosocial nature of this condition. The prevalence of psychopathology within this population is high, and this chapter reviews psychological factors that may accompany and exacerbate the experience of chest pain for some patients. Following this is a description of the clinical aspects of psychological diagnosis with this population, including differential diagnosis. We conclude with a review and analysis of the evidence-based intervention efforts conducted with these patients, particularly cognitive-behavioral approaches.