From the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 330 Brookline Ave, LY318, Boston, MA 02215.
At Psychiatry Grand Rounds in February 1999, Redford B. Williams, MD,
discussed the interactions between strong emotions and coronary heart disease.1 Mr A, the patient, had well-documented atherosclerotic
cardiovascular disease, accompanying diabetes mellitus, hypertension, and
a long history of depression, anxiety, and symptoms suggestive of panic attacks.
He noted that angina pectoris was frequently precipitated by arguments at
home, stressful conversations, and unanticipated events. Mr A was receiving
a complex cardiotonic regimen and required narcotics for control of painful
peripheral neuropathy. Dr Williams discussed the epidemiologic evidence for
interactions between stress and angina and offered strategies for managing
patients caught in this dangerous circumstance. Dr Williams suggested that
Mr A maintain his sense of humor and develop techniques for avoiding stressful
situations. For Mr A's family, Dr Williams recommended ways to offer positive
support and avoid confrontation.
Delbanco T, Hartman EE. A 69-Year-Old Man With Anger and Angina, 1 Year Later. JAMA. 2000;283(16):2151. doi:10.1001/jama.283.16.2151