Major depression, panic disorder, and mitral valve prolapse in patients who complain of chest pain.
OBJECTIVE
Patients with chest pain but without angiographic evidence of significant atherosclerotic coronary artery disease (CAD) are often found to have other medical or psychiatric disorders, including mitral valve prolapse, panic disorder (PD), and major depressive disorder (MDD). The purpose of this study was to determine the degree of comorbidity between MDD/PD and mitral valve prolapse in a group of patients with non-CAD chest pain.


METHODS
Patients referred for cardiac catheterization and coronary angiography for suspected CAD who were 70 years of age or younger and without other significant medical illnesses or cardiac complications were eligible for study. The first 100 patients who agreed to a psychiatric diagnostic interview were recruited.


RESULTS
Forty-eight of the 100 patients were found to be without significant CAD. Forty-two percent of these patients, compared to 19% of the patients with significant CAD, were found to have either MDD, PD, or both. Eighty percent of the patients without CAD who had mitral valve prolapse also had either MDD or PD (p less than 0.006).


CONCLUSIONS
The finding that mitral valve prolapse was significantly associated with MDD/PD has implications for the diagnosis and treatment of patients with non-CAD chest pain, and may explain why these patients complain of symptoms.
Carney
R M
RM
Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri.
Freedland
K E
KE
Ludbrook
P A
PA
Saunders
R D
RD
Jaffe
A S
AS
D006328:Cardiac Catheterization; D002637:Chest Pain / Q000209:etiology*; D015897:Comorbidity; D017023:Coronary Angiography; D003327:Coronary Disease / Q000175:diagnosis / Q000000981:diagnostic imaging; D003866:Depressive Disorder / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008945:Mitral Valve Prolapse / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D010200:Panic; D010698:Phobic Disorders / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*