The influence of anxiety and depression on outcomes of patients with coronary artery disease

For years, patients with cardiac disease have been thought to exhibit chara cteristic emotional features. However, the modern understanding of the rela tionship between affective disorders and the heart may be traced to the mid -19th century, with the publication of Williams' seminal text regarding "ne rvous and sympathetic palpitations of the heart."(1) This was followed thro ugh the late 1800s by numerous works that described the concept of neurolog ically based, or "neurasthenic," cardiac disorders. In the 20th century, la rge advances occurred in the area of mo-ed-related issues that pertained to coronary artery disease (CAD) and sudden cardiac death (SCD). In his 1910 Lumleian lecture, Sir William Osler described his typical patient with angi na pectoris as "a man whose engine is always set full speed ahead" and furt her noted his patients with cardiac disease to be "worriers."(2) The Mennin gers,(3) in early psychoanalytic studies, described a characteristic tenden cy to suppress anger among patients with CAD, as did Helen Flanders Dunbar, (4) a pioneer of psychosomatic medicine. More recently, Stewart Wolf, in hi s 1969 lecture "Psychosocial Forces in Myocardial Infarction and Sudden Dea th," commented on a phenomenon of "joyless striving" among his patients wit h heart disease.(5).