Increased cardiovascular risk associated with non-cardiac chest pain in patients with a prior psychiatric hospitalization: an opportunity and challenge for both the psychiatrist and the cardiologist

Abstract

This editorial refers to ‘Prior psychiatric hospitalization is associated with excess mortality in patients hospitalized with non-cardiac chest pain: a data linkage study based on the full Scottish population (1991–2006)’[†][1], by M. Gillies et al. , on page 760 The evaluation of patients with chest pain is a common problem for every cardiologist and one of the most frequent reasons for presentation to the emergency room. After diagnostic evaluation, only 15–25% of patients with chest pain are found to have an acute coronary artery syndrome (ACS).1,2 Improved strategies for stress testing, myocardial imaging, and the availability of sensitive biomarkers for myocardial damage such as high sensitivity troponin have reduced the risk of missing the diagnosis of an ACS. Once coronary artery disease, myocardial ischaemia, and/or injury are ruled out, both the patient and the physician often feel relieved. A specific diagnosis such as oesophageal reflux, peptic ulcer disease, herpes zoster, costochondritis, pulmonary embolism, or panic disorder often leads to specific therapy and pain relief. However, in many instances, despite intensive evaluation and reassurance as to the usually benign nature of non-cardiac chest pain (NCCP), the cause of the pain remains uncertain and/or the pain may reoccur with consequent patient frustration and distress. In these instances, the patient may be prescribed an antidepressant and/or enrolled in pain coping skills training (CST). For example, in a recent study, Keefe et al .3 randomized patients with a diagnosis of NCCP to one of four treatments: (i) CST plus the antidepressant sertraline; (ii) CST plus placebo; (iii) sertraline alone; or (iv) placebo alone. CST and sertraline either alone or in combination were found to reduce pain intensity and pain unpleasantness significantly. The authors suggest that the combination of CST and sertraline may have the greatest promise in … [1]: #fn-2