Personality traits associated with different chest pains after myocardial infarction.

Most patients who have had an acute myocardial infarction later experience pain in the chest of one sort or another. Angina pectoris is the commonest pain, and one in or including the left anterior chest is the next commonest single entity. The factors which determine post-infarction pain are complex. Clinical observation suggests that they include mental ones. Angina pectoris is often induced by emotion, and left chest pain in patients with heart disease has long been associated with anxiety. If mental factors associated with pain after myocardial infarction could be defined, more might be learnt of the mechanisms causing the pains and it might be possible to prevent some of them. The first difficulty faced in trying to relate mental factors to chest pains is that clinical judgements regarding the diagnostic category to which a pain belongs are often unreliable. This difficulty can be overcome if precise criteria are laid down for specified pain entities, and these criteria are sought by using standard questions which avoid the influence of the observer's bias. On this basis Rose (1962) proposed criteria for diagnosing angina pectoris in epidemiological studies. Extending this approach, we have recently classified pains occurring after myocardial infarction and have shown the reliability of the pain questionary on which the classification was based (Verghese and Lovell, 1966). The second difficulty arises from the fact that clinical judgements about mental traits are no more reliable than they are about the nature of chest pain, and similar problems of definitions exist (Carstairs, 1963). Cattell and Scheier (1961) have commented: " Theory and therapy are in a confused state essentially because one cannot be quite sure what another is talking about when he says 'anxiety' or 'neurosis,'" and they see as an answer to this the placing of instruments for meaningful and exact measurements in the hands of the clinician. Various attempts have been made to develop such instruments, including personality inventories and methods for measuring physiological and biochemical reactions to standard stressful situations. We have recently described the use of the latter method in a study in which catecholamine excretion and sympathetic nervous responses after a standard mental stimulus