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 characteristic emotional features. However, the modern understanding of the relationship between affective disorders and the heart may be traced to the mid-19th century, with the publication of Williams' seminal text regarding "nervous and sympathetic palpitations of the heart."(1) This was followed through the late 1800s by numerous works that described the concept of neurologically based, or "neurasthenic," cardiac disorders. In the 20th century, large 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 angina pectoris as "a man whose engine is always set full speed ahead" and further noted his patients with cardiac disease to be "worriers."(2) The Menningers,(3) in early psychoanalytic studies, described a characteristic tendency to suppress anger among patients with CAD, as did Helen Flanders Dunbar,(4) a pioneer of psychosomatic medicine. More recently, Stewart Wolf, in his 1969 lecture "Psychosocial Forces in Myocardial Infarction and Sudden Death," commented on a phenomenon of "joyless striving" among his patients with heart disease.(5).