Angina Pectoris and Angina Innocens

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Abstract
Patients (55) with anginoid pain were studied medically and psychologically. Twenty had angina pectoris, 20 had angina innocens, and 15 did not fulfill the criteria for either. Somatic and psychological features characteristic of each group are described. Somatic study included X-rays of chest, gall bladder and upper gastrointestinal system, ecg and Master''s two-step test. Psychological studies included psycho-dynamically oriented interviews, and study of personality and life situations. Data indicated that: (1) Denial of symptoms was marked in patients with angina pectoris, in contrast with dramatization of symptoms in those with angina innocens. (2) Hysterical and hypochondriacal symptoms, usually with phobias, characterized the angina innocens group. Depressive reactions predominated in angina pectoris. Anxiety and compulsive and dependent features were common in all patients. (3) Chronic emotional tension, super-imposed deterioration of life situations, and threats to personal security were associated with the onset of symptoms in all groups. (4) Pain and other symptoms were more diffuse in location and character in the angina innocens and mixed groups. Extracardiac causes for anginoid pain were found in all 3 groups but were most common in the angina innocens and mixed groups. Extracardiac conditions to which anginoid pain is often ascribable occurred asympto-matically in some patients. Presence of organic disease, including coronary arteriosclerosis, did not necessarily mean that it caused the pain. (5) Incidence of familial coronary artery disease was highest in angina pectoris. Cardiac symptoms by identification were observed in all 3 groups. Identifications were more diffuse in the angina innocens and mixed groups. (6) Patients with angina innocens had deep-seated anxiety focused on their hearts which drove them from doctor to doctor in search of relief for both their pain and anxiety. (7) Following somatic treatment and reassurance regarding their hearts, patients with angina innocens often displaced their complaints to other body systems or organs. When simple uncovering techniques and supportive psychotherapy were used, 3/4 of the patients in the angina innocens and mixed groups and 1/3 of those with angina pectoris were improved symptomatically. (8) Consideration of the patient''s psychological, social and physical attributes is essential in the evaluation, treatment, and prevention of anginoid pain.