Troubles with the brain that can be play an important role in harming the heart. “The overwhelming focus in the United States has been on ischemia,” the blockage of heart arteries, Dr. Mark Sullivan professor of psychiatry and behavioral sciences said. “That is pretty unique in the world. The rest of the world takes a much more multi-modal approach to chest pain. Ischemia is not the only or most important cause of what patients are feeling.”

“But in addition to the kind of diagnostic studies done with stress tests, patients who have a lot of angina should be screened for anxiety and depression, because they could be very cost-effective targets for intervention,” he said. “This is something many cardiologists tend not to be comfortable with,” Sullivan said and “at this point in time most primary-care physicians are comfortable with making an initial trial with treatment,” he said. “Many studies

have shown that depression is a predictor of mortality after a heart attack or in congestive heart failure,” said study author Nancy Frasure-Smith.