Document Detail


Psychological determinants of anginal pain perception during exercise testing of stable patients after recovery from acute myocardial infarction or unstable angina pectoris.
MedLine Citation:
PMID:  8540443     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The objective of this study was to test the hypothesis that psychological factors are determinants of anginal symptoms during positive exercise tests. The sample consisted of clinically stable patients who were enrolled in the Multicenter Study of Myocardial Ischemia 1 to 6 months after admission to a coronary care unit. Among 186 post-myocardial infarction patients, 151 developed ischemia (i.e., a stress-induced myocardial perfusion defect) without symptoms (silent ischemia) and 35 developed angina with ischemia (symptomatic ischemia) during a thallium exercise test; among 39 patients who had been hospitalized for unstable angina, 24 developed silent ischemia and 15 developed symptomatic ischemia. Two sets of psychometric tests were administered: set 1, factors that influence awareness of physical symptoms, and set 2, factors associated with biases toward or against reporting perceived symptoms. Two hundred eleven patients produced complete data in each set. Analysis of set 1 factor scores revealed significant effects of symptom status (p = 0.006) and index event (p = 0.02), but no interaction. No effects were found in set 2. Patients who are clinically stable after recovery from an acute coronary event and who experience angina during exercise testing are more aware of physical symptoms in general than are comparable patients with silent ischemia. Psychological biases toward or against reporting perceived symptoms do not differentiate these groups. Thus, it appears that silent ischemia is probably "silent" in the sense of being truly asymptomatic rather than of stoic endurance or denial of perceived symptoms.
Authors:
K E Freedland; R M Carney; R J Krone; N B Case; R B Case
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  The American journal of cardiology     Volume:  77     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  1996 Jan 
Date Detail:
Created Date:  1996-02-06     Completed Date:  1996-02-06     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1-4     Citation Subset:  AIM; IM    
Affiliation:
Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri 63178, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Angina Pectoris / physiopathology,  psychology*
Angina, Unstable / physiopathology,  psychology
Exercise Test*
Female
Humans
Male
Middle Aged
Multivariate Analysis
Myocardial Infarction / physiopathology,  psychology*
Pain Threshold*
Grant Support
ID/Acronym/Agency:
HL-38702/HL/NHLBI NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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