I have read that anxiety can be an early symptom of cardiac disorders. What screening tests would help clinicians detect an early cardiac problem presenting as an anxiety disorder?
—CAROL NEWMAN, MSN, CS, Punta Gorda, Fla. 

Anxiety and cardiovascular disease can coexist. There is evidence to suggest that anxiety may be an independent risk factor for cardiac disease, leading to poorer outcomes. While it is not yet clear whether the presence of anxiety (or anxiety disorders) leads to more rapid progression of coronary artery disease, the morbidity and costs associated with these disorders are sufficient to merit increased attention. A thorough psychosocial assessment and physical examination comprise the best screening tool. Any clinical findings of anxiety or anxiety-associated behavior should be further investigated. Assess for triggering events. Have the patient fill out a stress-related survey annually (e.g., the Holmes and Rahe Stress Scale). A baseline 12-lead ECG should also be performed. For more information, see Prim Psychiatry. 2005;
12:47-50.
—Debra Kleinschmidt, PhD, PA (124-6)