Noncardiac chest pain in the emergency department: the role of cardiac history, anxiety or depression and Type D personality

Eur J Cardiovasc Prev Rehabil. 2007 Apr;14(2):273-9. doi: 10.1097/HJR.0b013e32801da0fc.


Background: Noncardiac chest pain is common in patients presenting to emergency departments and is frequently associated with panic disorder. This can represent a major burden for patients and the healthcare system. Little is known about the patient characteristics that increase the risk of noncardiac chest pain. We examined whether cardiac history or Type D personality was associated with panic disorder and/or depression-driven noncardiac chest pain.

Methods and results: Patients presenting with noncardiac chest pain to the emergency department of the University Hospital Maastricht were screened using the Hospital Anxiety and Depression Scale (HADS). Patients scoring > or =8 on the HADS subscale were invited for a psychiatric interview; a consecutive sample of patients scoring <8 on the HADS was included as a reference group. Type D personality (tendency to experience emotional distress) was assessed with the DS14. Among the 304 HADS-positive patients, 89% were diagnosed with panic disorder/depression as compared with 8% of the 106 HADS-negative patients. Previous cardiac history was not associated with psychiatric diagnosis. Type D patients reported more anxiety symptoms (12.4+/-4.0 vs. 8.1+/-4.9) and depression symptoms on the HADS (10.2+/-4.7 vs. 5.8+/-4.9) and more often had comorbid panic disorder/depression (91/157=58% vs. 57/253=23%) than non-Type D patients (P<0.0001). Type D personality (odds ratio =8.67, 95% confidence interval 4.69-16.02), younger age and male sex were independently associated with increased risk of panic disorder or depression. Type D was independently associated with comorbid panic disorder/depression (odds ratio=14.49).

Conclusion: Type D personality, but not cardiac history, is independently associated with the presence of psychopathology in noncardiac chest pain. Type D is associated with a substantially increased risk of co-occurring PD/depression in these patients.

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Anxiety / complications*
  • Anxiety / epidemiology
  • Case-Control Studies
  • Chest Pain / epidemiology
  • Chest Pain / psychology*
  • Depression / complications*
  • Depression / epidemiology
  • Emergency Service, Hospital*
  • Female
  • Heart Diseases / complications
  • Heart Diseases / epidemiology
  • Humans
  • Logistic Models
  • Male
  • Mass Screening
  • Medical History Taking*
  • Middle Aged
  • Netherlands / epidemiology
  • Odds Ratio
  • Panic Disorder / complications*
  • Panic Disorder / epidemiology
  • Personality*
  • Predictive Value of Tests
  • Psychiatric Status Rating Scales
  • Sex Factors
  • Stress, Psychological / complications*
  • Stress, Psychological / epidemiology