Pain in my heart: chronic angina is linked to poor mental health among patients with spontaneous coronary artery dissection (2024)

Background

Spontaneous coronary artery dissection (SCAD) is an increasingly recognized form of acute coronary syndrome that often causes myocardial infarction, particularly among women. Even after their dissection has healed, a significant portion of these patients experience ongoing chest pain. Research with patients with obstructive forms of coronary artery disease shows that chronic angina is linked to mental health symptoms such as depression and anxiety and, in turn, mortality. To our knowledge, few studies have reported on angina burden among patients with SCAD, and no studies have examined the angina-mental health connection among this unique population. Given their young age, uncertainty about prognosis and treatment, and the prevalence of emotional stressors pre-SCAD, these patients may be at higher risk for chest pain and psychological distress post-SCAD.

Objective

The purpose of the study was to examine the association between angina burden, depression and anxiety among patients with SCAD.

Methods

Patients with a diagnosed SCAD were recruited from a cardiac care hospital. Patients completed a sociodemographic questionnaire and validated measures of angina burden (Seattle Angina Questionnaire; SAQ), depression (Patient Health Questionnaire-9; PHQ-9), generalized anxiety (Generalized Anxiety Disorder-7; GAD-7), cardiac-related anxiety (Cardiac Anxiety Questionnaire; CAQ) and posttraumatic stress (PTSD Checklist; PCL-5). Descriptive analyses and bivariate correlations were conducted.

Results

Participants (N=97; 80% female; M age=52 years; 75% White). Overall, patients’ angina-related health status fell in the poor to good category; lower scores were noted for angina stability (i.e., angina when doing strenuous activity). On average, patients reported experiencing angina on a monthly basis. Satisfaction of angina treatment was rated fair to good (M=70.8). About 20% of participants reported clinically elevated symptoms of depression and generalized anxiety, while 14% had scores indicating a probable diagnosis of posttraumatic stress. Cardiac-related anxiety was most prevalent; 40% of participants fell in the clinical range. All SAQ subscales (physical limitation, angina stability, angina frequency, angina treatment satisfaction, and QoL) were negatively associated with depression (r=.29-.41; ps<.004), generalized anxiety (r=.29-.39; ps<.007), cardiac-related anxiety (r=.34-.61; ps<.001) and posttraumatic stress (r=.29-.46; ps<.005).

Conclusions

These preliminary data suggest that chronic angina is strongly linked to mental health symptoms among patients who have experienced SCAD. As depression and anxiety have been previously associated with poor clinical outcomes, interventions to assist patients to cope with chronic angina may be required to enhance mental health and, possibly, improve cardiac outcomes.