Abstract
The author presented 8 cases of mild depression associated with cardiovascular disorders, and attempted to analyze the relationship between mild depression and cardiovascular disorders by a case study method. Patients were divided into two groups. The younger group (cases 1,2,3 and 4; their ages were 26,30,30 and 31 respectively) were found to have arrhythmias, and the elder group (cases 5,6,7 and 8; their ages 'were 50,59,67 and 53 respectively) showed anginal pains. The younger group mainly complained of palpitation, and their resting ECG records showed ventricular premature beats. After taking exercise or after changing their position from the supine to the upright position, their arrhythmias rapidly disappeared and conduction reverted to normal. In cases 1 and 2,P type (by Okinaka's criteria, sympathetic hyporeactor) was shown in the Mecholyl test. These findings suggested that in mild depression ventricular premature beats were caused by dysfunction (vagotonia) in the autonomic nervous system. In cases 5,6,7 and 8,patients mainly complaind of tightness in the chest or anginal pains. In case 5,patient's ECG records always showed normal findings. She was admitted to the hospital because of depression 10 years ago. Her character was very hypochondric and obsessive. She was diagnosed as depression associated with neurocirculatory asthenia. In case 6,patient's ECG records showed ischemic patterns (ST depression and T-wave inversion). He was also admitted to the hospital because of depression 10 years ago. Recently he was again in a depressive state after his daughter's marriage. He was diagnosed as emotional angina. In case 7,patient's husband died a year before admission, and in case 8,patient's sister and aunt suddenly died of heart disease about half a year before admission. Both of these patients began to suffer from chest troubles associated with melancholia after separation from their families by death. In cases 7 and 8,resting ECG records showed normal findings. Their ECG records, however, showed ST depression and T-wave inversion with sinus bradycardia in the morning in correspondence with patient's depressive states. In case 8,Mecholyl test showed P type. During the test, patient complained of chest tightness and at the same tine ischemic ST changes were demonstrated in ECG records. These two cases were diagnosed as rest angina. About the mechanism of causing these rest anginas, following processes can be assumed. Patient's depressive states might cause sinus bradycardia through their autonomic nervous system dysfunction, and consequently a decrease in coronary blood flow by bradycardia. In the final analysis by a decrease in coronary blood flow, chest tightness, anginal pain and abnormal ECG findings might be induced. Therefore, the author assumes that mild depression might play a certain role, as a causative and accelerating factor, in angina pectoris (especially in rest angina) in patients (particularly latent coronary sclerotic) with advanced age.
