The relation of chest pain symptoms to angiographic findings of coronary artery stenosis and neuroticism.

The present article examines the relations among self-reported and physician-estimated chest pain variables to angiographically determined coronary stenosis (CAD) and neuroticism scores. Six of the 48 chest pain variables were significantly related to coronary stenosis, but only one variable, chest pain elicited by walking, was positively related to stenosis. Chest pain during sleep, sighing and dizziness accompanying chest pain, right lower chest pain radiation, and infrequent rest to cope with the chest pain were significantly negatively related to stenosis. Neuroticism scores (N) were not significantly related to CAD but were significantly correlated with 13 of the 48 chest pain variables. In addition to correlating positively with the chest pain variables that were negatively correlated with CAD, N scores were significantly related to higher pain severity ratings, being angry, annoyed, tense, afraid, worried, and upset before the chest pain, breathlessness during the pain episode, and pain sensations described as stabbing. The six chest pain variables significantly correlated with CAD yielded a multiple correlation of 0.58, accounting for 34% of the variance, whereas N scores accounted for only 5% of the variance; however, N contributed less than 1% unique variation to stenosis in combination with the six chest-pain variables. That N influences chest pain reports more than actual stenosis is further confirmed by the results of physicians' ratings of their patients' typical chest pain episodes. Recognition of patients' characteristic levels of distress or neuroticism may aid physicians in evaluating symptoms more accurately and in treating their chest pains more appropriately.

Duke Scholars

Author Paul T. Costa Jr. Medicine, Geriatrics and Palliative Care