Browse > Article
http://dx.doi.org/10.3344/kjp.2016.29.4.262

Depression masquerading as chest pain in a patient with Wolff Parkinson White syndrome  

Madabushi, Rajashree (Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences)
Agarwal, Anil (Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences)
Tewari, Saipriya (Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences)
Gautam, Sujeet KS (Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences)
Khuba, Sandeep (Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences)
Publication Information
The Korean Journal of Pain / v.29, no.4, 2016 , pp. 262-265 More about this Journal
Abstract
Wolff Parkinson White (WPW) syndrome is a condition in which there is an aberrant conduction pathway between the atria and ventricles, resulting in tachycardia. A 42-year-old patient, who was treated for WPW syndrome previously, presented with chronic somatic pain. With her cardiac condition in mind, she was thoroughly worked up for a recurrence of disease. As part of routine screening of all patients at our pain clinic, she was found to have severe depression as per the Patient Health Questionnaire-9 (PHQ-9) criteria. After ruling out sinister causes, she was treated for depression using oral Duloxetine and counselling. This led to resolution of symptoms, and improved her mood and functional capability. This case highlights the use of psychological screening tools and diligent examination in scenarios as confusing as the one presented here. Addressing the psychological aspects of pain and adopting a holistic approach are as important as treatment of the primary pathology.
Keywords
Chronic pain; Depression; Duloxetine; Psychological tools; Somatic pain; WPW syndrome;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Munger TM, Packer DL, Hammill SC, Feldman BJ, Bailey KR, Ballard DJ, et al. A population study of the natural history of Wolff-Parkinson-White syndrome in Olmsted County, Minnesota, 1953-1989. Circulation 1993; 87: 866-73.   DOI
2 Fitzsimmons PJ, McWhirter PD, Peterson DW, Kruyer WB. The natural history of Wolff-Parkinson-White syndrome in 228 military aviators: a long-term follow-up of 22 years. Am Heart J 2001; 142: 530-6.   DOI
3 Nakagawa S, Maeda K, Imamura T, Kondoh H, Koiwaya Y, Tanaka K. Increasing pre-excitation ("concertina effect") during vasospastic angina. J Electrocardiol 1986; 19: 299-302.   DOI
4 Wang AC, Chen SJ, Lee PC, Hwang BT, Tsai MC. Variant angina in an adolescent coexisting with intermittent Wolff-Parkinson-White syndrome. Am J Emerg Med 2008; 26: 968.e5-7.
5 Pappone C, Santinelli V, Manguso F, Augello G, Santinelli O, Vicedomini G, et al. A randomized study of prophylactic catheter ablation in asymptomatic patients with the Wolff-Parkinson-White syndrome. N Engl J Med 2003; 349: 1803-11.   DOI
6 Yalin K, Golcuk E, Bilge AK, Umman S, Adalet K. Successful stenting of a left main coronary artery occlusion as a complication of RF ablation for Wolff-Parkinson-White syndrome. Pacing Clin Electrophysiol 2012; 35: e43-6.   DOI
7 Kulawik T, Kaluza B, Kusnierz J. Acute coronary syndrome during dissection of left main as a complication of radiofrequency ablation. Kardiol Pol 2012; 70: 190-2.
8 Kaya MG, Ozdogru I, Yarlioglues M, Inanc T, Dogan A, Eryol NK. Coronary ischemia induced Wolf Parkinson White syndrome. Int J Cardiol 2008; 129: e3-4.   DOI
9 Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001; 16: 606-13.   DOI
10 White KS, Raffa SD, Jakle KR, Stoddard JA, Barlow DH, Brown TA, et al. Morbidity of DSM-IV Axis I disorders in patients with noncardiac chest pain: psychiatric morbidity linked with increased pain and health care utilization. J Consult Clin Psychol 2008; 76: 422-30.   DOI
11 Eifert GH, Hodson SE, Tracey DR, Seville JL, Gunawardane K. Heart-focused anxiety, illness beliefs, and behavioral impairment: comparing healthy heart-anxious patients with cardiac and surgical inpatients. J Behav Med 1996; 19: 385-99.   DOI
12 Eifert GH, Zvolensky MJ, Lejuez CW. Heart-focused anxiety and chest pain: a conceptual and clinical review. Clin Psychol (New York) 2000; 7: 403-17.
13 Chambers JB, Marks EM, Russell V, Hunter MS. A multidisciplinary, biopsychosocial treatment for non-cardiac chest pain. Int J Clin Pract 2015; 69: 922-7.   DOI
14 Chambers JB, Marks E, Knisley L, Hunter M. Non-cardiac chest pain: time to extend the rapid access chest pain clinic? Int J Clin Pract 2013; 67: 303-6.   DOI
15 Guzman J, Esmail R, Karjalainen K, Malmivaara A, Irvin E, Bombardier C. Multidisciplinary bio-psycho-social rehabilitation for chronic low back pain. Cochrane Database Syst Rev 2002: CD000963.
16 Webster R, Norman P, Goodacre S, Thompson AR, McEachan RR. Illness representations, psychological distress and non-cardiac chest pain in patients attending an emergency department. Psychol Health 2014; 29: 1265-82.   DOI
17 Lunn MP, Hughes RA, Wiffen PJ. Duloxetine for treating painful neuropathy, chronic pain or fibromyalgia. Cochrane Database Syst Rev 2014: CD007115.
18 Coplan JD, Aaronson CJ, Panthangi V, Kim Y. Treating comorbid anxiety and depression: psychosocial and pharmacological approaches. World J Psychiatry 2015; 5: 366-78.   DOI