8 - Chest Pain Syndromes

Summary

The modern history of functional chest pain syndromes begins with ‘soldiers heart’, first described in 1860 by British physicians during the Crimean War, when previously healthy soldiers developed debilitating chest pains (Castell, 1992). At the same time on the American side of the Atlantic, DaCosta described ‘irritable heart’ in Civil War soldiers (Jarcho, 1959). In 1883 Kronecker & Meltzer reported that mental distress was associated with esophageal contractions, and by the end of the century Osler's Principles and Practice of Medicine had made the terms ‘oesophagismus’ and ‘pseudoangina’ familiar to physicians, linking both conditions to hysterical women and neurasthenic men (Osler, 1892).

All of these early descriptions of chest pain syndromes note an association with anxiety, but Jones & Lewis (1941) published the first large study of the psychological aspects of patients with recurrent chest pain and found unusually high frequencies of acute anxiety (17%), chronic anxiety state (14%), psychopathic personality (18%), depression (12%) and hysteria (11%).

Sophisticated studies of the pathophysiology of chest pain in patients without serious heart disease began with Likoff's report of 15 women with recurrent chest pain, abnormal electrocardiograms (ECGs), and normal coronary angiograms (Likoff et al., 1967). That same year Kemp et al. (1967) reported evidence for cardiac ischemia by ECG and stress testing in 27% of a sample of 50 patients with recurrent chest pain and normal coronary angiograms.