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Understanding Chest Pain: What Every Psychologist Should Know
Authors:Steven M Schwartz  Peter C Trask  Mark W Ketterer
Institution:(1) Behavioral Medicine Program, University of Michigan Health Systems, Ann Arbor, Michigan;(2) Behavioral Medicine Program/Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, Michigan, 48108;(3) Henry Ford Health Sciences Center, Detroit, Michigan
Abstract:Chest pain is one of the most frequent presenting complaints in Emergency Rooms and other medical settings. A considerable number of these patients do not have significant coronary artery disease. This led to plausible alternative explanations for these presenting symptoms and these patients tend to have unremarkable cardiac outcomes. Nevertheless, many studies have also documented that symptoms and related disability persist in the face of reassurances about benign cardiac status. Given the implied threat of chest pain (e.g., myocardial infarction) and the presence of chest pain symptoms in other noncardiac conditions (including anxiety and panic), it is not surprising that many of these patients present with considerable emotional distress. Consequently, chest pain symptoms represent diagnostic and treatment dilemmas for physicians and psychologists alike. The extent to which cardiac and noncardiac factors contribute to all forms of chest pain remains unknown. The function of this review is to provide mental health professionals with a primer on relevant clinical issues in chronic chest pain. We examine several common medical and psychiatric causes of chronic chest pain and selectively review (1) the relevant medical and psychiatric diagnostic and treatment considerations for chest pain and (2) the hypothetical biobehavioral mechanisms relevant to psychological intervention, (3) while expanding on existing conceptual models for understanding chest pain, and (4) offering some suggestions for future research.
Keywords:chest pain  panic  angina  cardiovascular disease  self-management
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