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Clinical Crossroads Update
April 26, 2000

A 69-Year-Old Man With Anger and Angina, 1 Year Later

Author Affiliations

From the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 330 Brookline Ave, LY318, Boston, MA 02215.

JAMA. 2000;283(16):2151. doi:10.1001/jama.283.16.2151

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.

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