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Clinical Crossroads
August 25, 1999

A 69-Year-Old Man With Anger and Angina

Author Affiliations

Author Affiliation: Dr Williams is Director, Behavioral Medicine Research Center, Duke University Medical Center and Professor of Psychiatry and Behavioral Sciences, Professor of Psychology, and Associate Professor of Medicine, Duke University, Durham, NC.


Clinical Crossroads at Beth Israel Deaconess Medical Center is produced and edited by Thomas L. Delbanco, MD, Jennifer Daley, MD, and Richard A. Parker, MD; Erin E. Hartman, MS, is managing editor. Clinical Crossroads section editor: Margaret A. Winker, MD, Deputy Editor, JAMA.

JAMA. 1999;282(8):763-770. doi:10.1001/jama.282.8.763

Dr Delbanco: Mr A is a 69-year-old married, retired government worker with a 27-year history of angina pectoris, often triggered by stress. A father of several children, he lives in Boston and has Medicare and supplementary insurance. He has long received care in Veterans Affairs hospitals, but for the past 2 years, Dr M, a general internist at the Beth Israel Deaconess Medical Center, has been his primary provider.

Mr A developed angina in the early 1970s. Despite medical intervention, he has since frequently developed angina with exertion, such as carrying bundles. In the past, Mr A describes "not getting along too well" with his cardiologist, who "yelled at him" about his excessive weight and felt his chest symptoms reflected panic, rather than arterial disease. He also sought help from a psychiatrist who helped him with depression and sleep problems.