Document Detail

Angina pectoris during daily activities and exercise stress testing: The role of inducible myocardial ischemia and psychological distress.
MedLine Citation:
PMID:  18694624     Owner:  NLM     Status:  MEDLINE    
Physicians often consider angina pectoris to be synonymous with myocardial ischemia. However, the relationship between angina and myocardial ischemia is highly variable and we have little insight into the sources of this variability. We investigated the relationship of inducible myocardial ischemia on SPECT stress perfusion imaging to angina reported with routine daily activities during the previous four weeks (N=788) and to angina reported during an exercise stress test (N=371) in individuals with confirmed or suspected coronary disease referred for clinical testing. We found that angina experienced during daily life is more strongly and consistently associated with psychological distress and the personal threat associated with angina than with inducible myocardial ischemia. In multivariable models, the presence of any angina during routine activities over the prior month was significantly associated with age, perceived risk of myocardial infarction, and anxiety when compared to those with no reported angina in the past month. Angina during daily life was not significantly associated with inducible myocardial ischemia on stress perfusion imaging in bivariate or multivariable models. In contrast, angina experienced during exercise stress testing was significantly related to image and ECG ischemia, though it was also significantly associated with anxiety. These results suggest that angina frequency over the previous four weeks is more strongly associated with personal threat and psychosocial distress than with inducible myocardial ischemia. These results lend support to angina treatment strategies that aim to reduce threat and distress as well as to reduce myocardial ischemia.
Mark D Sullivan; Paul S Ciechanowski; Joan E Russo; John A Spertus; Laurie A Soine; Kier Jordan-Keith; James H Caldwell
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2008-08-09
Journal Detail:
Title:  Pain     Volume:  139     ISSN:  1872-6623     ISO Abbreviation:  Pain     Publication Date:  2008 Oct 
Date Detail:
Created Date:  2009-08-07     Completed Date:  2009-09-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7508686     Medline TA:  Pain     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  551-61     Citation Subset:  IM    
Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, 98195-6560, USA.
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MeSH Terms
Activities of Daily Living*
Affective Symptoms / complications,  physiopathology
Age Factors
Angina Pectoris / etiology*,  physiopathology,  psychology,  radionuclide imaging
Anxiety / complications*,  physiopathology
Exercise Test*
Heart / radionuclide imaging*
Middle Aged
Myocardial Infarction / surgery,  therapy
Myocardial Ischemia / complications*,  physiopathology,  radionuclide imaging
Risk Factors
Smoking / adverse effects
Stress, Psychological / complications*,  physiopathology
Tomography, Emission-Computed, Single-Photon

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