Sönmez Nesibe DEMİRYOĞURAN, Hakan TOPAÇOĞLU, Özgür KARCIOĞLU

Nonspesifik göğüs ağrılı hastalarda anksiyete bozukluğu

Acil servise göğüs ağrısı şikayeti ile başvuran hastaların çoğu, akut koroner sendrom ve hayatı tehdit eden diğer durumlar dışlandıktan sonra nonspesifik göğüs ağrısı tanısı ile taburcu edilmektedir. Yapılan çalışmalar, nonspesifik göğüs ağrısı tanısı alan hastalarda yüksek oranda anksiyete bozukluğu bulunduğunu göstermiştir. Anksiyete bozukluğu, tanısı konulduğunda etkin bir şekilde tedavi edilebilen bir hastalıktır. Anksiyete bozukluğu hastalarının çoğu ilk olarak psikiyatri kliniklerinden daha çok acil servis veya kardiyoloji bölümlerine başvurur. Bu nedenle göğüs ağrısı şikayeti ile başvuran hastalarda göğüs ağrısını açıklayacak organik bir patoloji saptanamadığı durumlarda, hekimlerin anksiyete bozukluğunu, ayırıcı tanılar arasında göz önünde tutmaları ve hastayı ilgili birimlere yönlendirmeleri önemlidir. Nonspesifik göğüs ağrısı tanısını alan hastaların; ağrılarının akut koroner sendrom açısından atipik karakterde olması, yineleyen acil servis başvurularının olması ve göğüs ağrısına eşlik eden birçok semptom tanımlaması, acil servis hekiminin anksiyete bozukluğundan şüphelenmesine yardımcı olabilir.

Anahtar Kelimeler:

Kaygı, Kaygı bozuklukları, Göğüs ağrısı, Acil tıp servisleri, Panik bozukluğu

Anxiety disorder in patients with nonspecific chest pain

Most patients admitted to the emergency department (ED) with chest pain are discharged with a diagnosis of "nonspecific chest pain" (NSCP) after ruling out acute coronary syndrome and other life-threatening conditions. Recent studies have shown that anxiety disorder commonly accompanied NSCP. Anxiety disorder is an entity which can be efficiently treated and cured once suspected and diagnosed. Provided that patients commonly enter the health care system via EDs and cardiology outpatient clinics, a high index of suspicion pursued by EPs is of utmost importance to detect anxiety disorder in patients with chest pain. Emergency physicians should always consider anxiety disorder in. patients presenting with chest pain provided that organic pathologies are ruled out. Atypical definitions of pain in the history, recurrent visits to the ED and having numerous adjunctive complaints should raise suspicions having anxiety disorder.

Keywords:

Anxiety, Anxiety Disorders, Chest Pain, Emergency Medical Services, Panic Disorder,

PDF

___

1. Green GB, Hill PM. Cardiovascular disease: Approach to chest pain and possible myocardial ischemia. In; Emergency Medicine: A Comprehensive Study Guide, 5th ed. Tintinalli JE, Kelen GD, Stapczynski JS (eds). North Carolina: McGraw-Hill, 1999;341 -351.
2. Weingarten SR, Ermann B, Riedinger MS. Selecting the best triage rule for patients hospitalized with chest pain. AmJMedl989;87:494.
3. Gibbons RJ, Abrams J, Chatterjee K et al. ACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina, 17 Kasım 2002.
4. O'Rourke RA, Shaver JA, Silverman ME. Hikaye, Fizik Muayene ve Oskültasyon. In; Hurst's The Heart, 10. baskı,Türkçe. Fuster V, Alexander RW, O'Rourke RA(eds) (çeviri ed: Yılmaz Y, Şahinbaş E) McGraw-Hill 2002;1 93-281.
5. Solinas L, Raucci R, Terrazzino S et al. Prevalence, clinical characteristics, resource utilization and outcome of patients with acute chest pain in the emergency department. A multicenter, prospective, observational study in north-eastern Italy. Ital Heart J 2003;4:318-324.
6. Eslick GD, Fass R. Noncardiac chest pain: evaluation and treatment. Gastroenterol Clin North Am 2003;32:531-552.
7. Karlson BW, Wiklund I, Bengston A, Herlitz J. Prognosis and symptoms one year after discharge from the emergency department in patients with acute chest pain. Chest 1994;105:1442-1447.
8. Fleet RP, Dupuis G, Marchand A et al. Panic disorder in coronary artery disease patients with noncardiac chest pain. J Psychosom Res 1998;44:81-90.
9. Katon W. Panic disorder: relationship to high medical utilization, unexplained physical symptoms, and medical costs. J Clin Psychiatry 1996; 57:11-8; 19-22
10. Chambers J, Bass C. Atypical chest pain: looking beyond .the heart. QJM 1998;91:239-244.
11. Wong WM, Lam KF, Cheng C et al. Population based study of noncardiac chest pain in southern Chinese: prevalence, psychosocial factors and health care utilization. World J Gastroenterol 2004 ;10:707-712.
12. Beitman BD, Mukerji V, Lamberti JW et al. Panic disorder in patients with chest pain and angiographically normal coronary arteries. Am J Cardiol 1990;15;1048.
13. Kontos MC. Evaluation of the Emergency Department chest pain patient. Cardiol Rev 2001; 9:266-275.
14. Gibler WB, Runyon JP, Levy RC et al. A rapid diagnostic and treatment center for patients with chest pain in the emergency department. Ann Emerg Med 1995;25: 1.
15. Wulsin LR, Arnold LM, Hillard JR. Axis I disorders in ER patients with atypical chest pain. In t J Psychiatry Med 1991; 21:37-46.
16. Ayuso Mateos JL, Bayon Perez C, Santo-Domingo Carrasco J, Olivares D. Atypical chest pain and panic disorder. Psychother Psychosom 1989; 52:92-95.
17. Beitman BD, Basha I, Flaker G et al. Atypical or nonanginal chest pain. Panic disorder or coronary artery disease? Arch Intern Med 1987 ;147:1548-1552.
18. Wulsin L, Liu T, Storrow A, Evans S, Dewan N, Hamilton C. A randomized, controlled trial of panic disorder treatment initiation in an emergency department chest pain center. Ann Emerg Med 2002;39:139-143.
19. Wulsin LR, HiUard JR, Geier P, Hissa D, Rouan GW. Screening emergency room patients with atypical chest pain for depression and panic disorder. Int J Psychiatry Med 1988;18:315-323.
20. Katon W, Hall ML, Russo J et al. Chest pain: relationship of psychiatric illness to coronary arteriographic results. Am J Med 1988;84:l-9.
21. Dammen T, Arnesen H, Ekeberg O, Husebye T, Friis S. Panic disorder in chest pain patients referred for cardiological outpatient investigation. J Intern Med 2000; 247:518-519.
22. Tueth MJ. Managing recurrent nonischemic chest pain in the emergency department.Am J Emerg Med 1997;15:170-172.
23. Sürmeli A. Anksiyete Kavramı ve Anksiyete Bozukluklarına Genel Bir Bakış. Psikiyatri Temel Kitabı. Güleç C, Köroğlu E (editörler). Ankara: Hekimler Yayın-Birliği, 1997; 429-449.
24. Bayraktar E, Atalay ND. Panik bozukluğu ve agorafobi. Psikiyatri Temel Kitabı. Güleç C, Köroğlu E (editörler). Ankara: Hekimler Yayın Birliği, 1997; 461-479.
25. Fleet RP, Dupuis G, Marchand A, Burelle D, Beitman BD. Panic disorder, chest pain and coronary artery disease: Literature review. Can J Cardiol 1994; 10:827-834.
26. Huffman JC, Pollack MH, Stern TA. Panic Disorder and Chest Pain: Mechanisms, Morbidity, and Management. Prim Care Companion J Clin Psychiatry 2002;4:54-62.
27. Kuijpers PM, Honig A, Griez EJ, Braat SH, Wellens HJ. [Panic disorder, chest pain and palpitations: a pilot study of a Dutch First Heart Aid] Ned Tijdschr Geneeskd 2000;l44:732-736.
28. Kuijpers PM, Honig A, Griez EJ, Braat SH, Wellens HJ. [Panic disorder in patients with chest pain and palpitations: an often unrecognized relationship] Ned Tijdschr Geneeskd 2000;l44:745-749.
29. Yingling KW, Wulsin LR, Arnold LM, Rouan GW. Estimated prevalences of panic disorder and depression among consecutive patients seen in an emergency department with acute chest pain. J Gen Intern Med 1993;8:231-235.
30. Roll M, Kollind M. Theorell Five-year follow-up of young adults visiting an emergency unit because of atypical chest pain. Intern Med 1992;231:59-65.
31. Bass C. Chest pain and breathlessness: relationship to psychiatric illness. Am J Med 1992; 24;92:12-17.
32. Roy-Byrne PP. Generalized anxiety and mixed anxiety- depression: association with disability and health care utilization. J Clin Psychiatry 1996;57:86-91.
33. Tew R, Guthrie EA, Creed FH, Cotter L, Kisely S, Tomenson B. A long-term follow-up study of patients with ischaemic heart disease versus patients with nonspecific chest pain. J Psychosom Res 1995;39:977-985.
34. Potts SG, Bass CM. Psychological morbidity in patients with chest pain and normal or near-normal coronary arteries: a long-term follow-up study. Psychol Med 1995;25:339-247.
35. Carter C, Maddock R, Amsterdam E, McCormick S, Waters C. Billett- Panic disorder and chest pain in the coronary care unit. Psychosomatics 1992;33:302-309.
36. Fleet RP, DuPuis G, Marchand A, Burelle D, Arsenault A, Beitman BD. Panic disorder in emergency departmant chest pain patient: prevalence, comorbidity, suicidal ideation and physician recognition. Am J Med 1996; 101:371-380.
37. Kushner MG, Beitman BD, Beck NC. Factors predictive of panic disorder in cardiology patient with chest pain and no evidence of coronary artery disease. J Psychosom Res 1989; 33:207-215
39. Huffman JC, Pollack MH. Predicting panic disorder among patients with chest pain: an analysis of the literature. Psychosomatics 2003; 44:222-236.
40. Barkın RL, Leikin JB, Barkın SJ. Noncardiac Chest Pain: A Focus on Psychogenic Causes. Am J Ther 1994; 1:321-326.
41. Rutledge T, Reis SE, Olson M et al. History of anxiety disorders is associated with a decreased likelihood of angiographic coronary artery disease in women with chest pain: the WISE study. J Am Coll Cardiol 2001; 37:780-785.
42. Sönmez N. Nonspesifik göğüs ağrılı olgularda anksiyete bozukluğu sıklığı ve karakteristikleri. Dokuz Eylül Üniversitesi Tıp Fakültesi Acil Tıp AnabilimDalı, 2004 İzmir.
43. Bjelland I, Dahi AA, Haug TT, Neckelmann D, The validity of the Hospital Anxiety and Depression Scale: an updated literature review. J Psychosom Res 2002; 52.
44. Aydemir Ö, Güvenir T, Küey L. Hastane Anksiyete ve Depresyon Ölçeği Türkçe Formunun Geçerlilik ve Güvenilirlik Çalışması. Türk Psikiyatri Dergisi 1997; 8:280.
45. Kuijpers PM, Denollet J, Lousberg R, et al. Validity of the hospital anxiety and depression scale for use with patients with noncardiac chest pain.Psychosomatics 2003;44:329.
46. Weiller E, Bisserbe JC, Maier W, Lecrubier Y. Prevalence and recognition of anxiety syndromes in five European primary care settings. A report from the WHO study on Psychological Problems in General Health Care. Br J Psychiatry Suppl 1998; 34: 18-22.