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Many patients with no CHD have persistent symptoms

Almost three-quarters of patients investigated for coronary heart disease (CHD), and given the all-clear, still have persistent symptoms up to 18 months later, indicates a small study from researchers at the Heart Centre, University Hospital Dresden, Germany, published recently in the online journal Open Heart.

Certain investigations seem to deepen fears about heart health and perpetuate physical symptoms, the findings suggest.

Around one in five patients with chest pain will have no obvious signs of coronary artery disease after investigation, and their symptoms are unlikely to have a physical cause.

But it is not always clear who these patients are, and they often undergo extensive and expensive tests to find out that nothing is wrong with their hearts.

The German authors therefore wanted to test the prevalence of physical and mental symptoms in 253 patients who had been investigated for chest pain/shortness of breath/palpitations and found to have no coronary artery disease.

Screen shot 2014-10-31 at 12.16.04The type and intensity of their symptoms were tested before  and 6 to 18 months after they had undergone coronary angiography—an invasive procedure designed to take x-ray pictures of the heart.

They also completed a series of validated questionnaires to check on their levels of general anxiety and depression, heart focused anxiety, hypochondria, physical symptoms prompted by state of mind (somatoform disorder) and quality of life.

The results were compared with those of a representative sample of the German population without any history of heart disease.

Before the angiography, symptoms were severe for almost one in 10 patients (more than 8.5%) and moderate in around one in four (28%).

Afterwards, seven out of 10 patients continued to have symptoms, despite having no detectable evidence of coronary artery disease.

Compared with the general population their anxiety levels were considerably higher (37% higher in women and 22% higher in men) and their specific heart focused anxiety was 27% higher.

Similarly, the incidence of somatoform disorders was 120% more common, and these patients were 68% more likely to be suffering from hypochondria. Unsurprisingly, their stress and anxiety levels were reflected in significantly lower quality of life scores.

The researchers conclude that while the validated questionnaires take a bit of time to complete, they are worth doing to stave off the likelihood of further expensive and potentially invasive tests and to ensure that these patients get the psychological help they need.


1. Christoph M, Christoph A, Dannemann S, et al. Mental symptoms in patients with cardiac symptoms and normal coronary arteries. Open Heart 2014;1:e000093.

Published on: October 31, 2014

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