Hearts and minds: psychological factors and the chest pain of cardiac syndrome X

This editorial refers to “Distinct psychosocial differences between women with coronary heart disease and cardiac syndrome X” 1 by E.A. Asbury et al. on page 1695 The pathophysiology of cardiac syndrome X (CSX, anginal pain and ischaemic-like stress ECG despite angiographically normal coronary arteries) has evolved from a paradigm centred around myocardial ischaemia, via the conceptual bridge of abnormal autonomic neural regulation of the heart, to one based upon neurophysiological differences affecting pain perception.1 The direction of therapeutic strategies has moved in parallel. This development of thinking has brought with it an increased interest in psychological factors.In the present issue of the European Heart Journal , Asbury et al., report an extensive study of psychosocial factors and the ill health of women with CSX, as compared to women with known coronary artery disease (CAD) and normal controls.2 The definition of CSX was strict and included `angiographically smooth coronary arteries'. Asbury et al's principal focus has been (a) the psychological profile of the CSX patients vs. CAD patients and (b) oestrogen status (see below).The principal psychological findings were that patients with CSX patients displayed greater anxiety than CAD patients who, in turn were more anxious than normals. There was an equivalent degree of depression in both patient groups but both were more depressed than normals; both patient groups reported higher total Health Anxiety Questionnaire (HAQ) scores than normals (this relates to worry and preoccupation, fear of illness and life interference). There was a similar prevalence of family history of CAD in both patient groups.There were no differences among the three groups for size of social network. Both patient groups, when they had small social networks, had higher Hospital Anxiety and Depression Scale (HADS) depression and interference with life. There was no difference in the prevalence of … *Correspondence to: Stuart D. Rosen, MD, Department of Cardiology, Ealing Hospital, Uxbridge Road, Middlesex UB1 3HW, UK. Tel.: +44-208-967-5359; fax: +44-208-967-5007
 stuart.rosen{at}imperial.ac.uk