The effect on anxiety level of coronary angiographic result and the perception of pain

Derya Atik, Cem Atik, Hilal Karatepe, Celalettin Karatepe, Sezgi Çınar


Background: The problems and complications experienced by the patients who underwent a CAG due to their pain and anxiety can be minimized through a care plan prepared to meet their needs and a coordinated teamwork. In this prospective and descriptive study we aimed at determining the effect of coronary angiography results and perceived pain on anxiety level in patients who undergoing coronary angiography.

Methods: The study was carried out with patients who were implemented coronary angiography for the first time at the cardiology clinic of Osmaniye private new life hospital between May 2014 and August 2014. The study data were collected using the State-Trait Anxiety Inventory (STAI), a verbal pain rating scale and a questionnaire that was prepared by the investigators. The descriptive data are given in the form of arithmetic mean Standard Deviation (SD), numbers and percentage distribution. The correlations between the variables were assessed using crosstabs, one-way ANOVA and the Pearson's correlation analysis. The data were evaluated in 95% confidence interval and at a significance level of P <0.05.  

Results: 35.9% of the patients stated that they felt severe pain. The mean anxiety score was 36.746.81 and those who felt very severe and unbearable pain had higher mean anxiety scores (P <0.01). Those who had three coronary diseases had higher anxiety levels (41.149.30) than those who had an atherosclerotic stenosis and #8805;50% (normal) (35.945.49) (P <0.01). Gender had an influence on pain levels (P <0.01).  

Conclusion: Coronary angiography results and pain perception were determined to be statistically significant effects on anxiety level. A statistically significant correlation was found between pain and anxiety. In general, pain and anxiety affect each other positively; an increase in one results in an increase in the other.



Pain, Anxiety, Coronary angiography

Full Text:



World Health Organization (WHO). The top ten causes of death, 2010. Available at:

Onat A. Report on cardiac diseases in Turkish adults and their risk factors, 2009. Available at:

Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, et al. ACC/AHA 2007 Guidelines for the management of patients with unstable angina/non-st-elevation myocardial infarction. J Am Coll Cardiol. 2007;50(7):654-9.

Avsar G, Kasikçi M. Evaluation of patient education provided by clinical nurses in Turkey. Int J Nurs Pract. 2001;17:67-71.

Bally B, Campbell D, Chesnick K, Tranmer JE. Effects of patient controlled music therapy during coronary angiography on procedural pain and anxiety distress syndrome. Crit Care Nurse. 2003;23(2):50-7.

Vural M, Acer M, Akbaş B. The scores of Hamilton depression, anxiety, and panic agoraphobia rating scales in patients with acute coronary syndrome. Anatol J Cardiol. 2008;8:43-7.

Todaro JF, Shen BJ, Raffa SD, Tilkemeier PL, Niaura R. Prevalence of anxiety disorders in men and women with established coronary heart disease. Med J. 1998;169(11-12):663-6.

Spielberger CD, Gorsuch RL, Lushene RE. Manual for the state-trait anxiety inventory. In: Spielberger CD, Gorsuch RL, Lushene RE, eds. The Manual. Palo Alto, CA: Consulting Psychologists Press; 1970.

Öner N, Le Compte A. State and trait anxiety inventory - manual (Turkish). In: Öner N, Le Compte A, eds. The Manual. İstanbul: Bogazici University Press; 1993.

Summer GJ, Puntillo KA. Management of surgical and procedural pain in a critical care setting. Crit Care Nurs Clin North Am. 2001;13(2):233-42.

Aslan FE. The assessment methods of pain. J Cumhuriyet Univ School Nurs. 2002;6(1):9-16.

Türkoğlu M. Cancer-related pain. In: Yeğül İ, eds. Pain and Treatment. 1st ed. Izmir: Production Printing; 1993:123-144.

Kocaman G. Pain. In: Kocaman G, eds. Nursing Approaches. 1st ed. Izmir: Saray Medical Publishing; 1994.

Cheever KH. Reducing the effects of acute pain in critically ill patients. Dimens Crit Care Nurs. 1999;18(3):14-23.

Hancock H. The complexity of pain assessment and management in the first 24 hours after cardiac surgery: implications for nurses. Part 2. Intensive Crit Care Nurs. 1996;12(6):346-53.

Merriweather N, Sulzbach-Hoke LM. Managing risk of complications at femoral vascular access sites in percutaneous coronary intervention. Crit Care Nurse. 2012;32:16-29.

Ercan S, Karslı VM, Davutoğlu V, Huraibat A, Oylumlu M, İnanç Hİ, Yüce M, et al. Comparison of controlled pressure belt-allowing mobility - to sandbags after percutaneous coronary intervention: pilot study. Arch Turk Soc Cardiol. 2013;41(8):699-704.

Choussat R, Black A, Bossi I, Fajadet J, Marco J. Vascular complications and clinical outcome after coronary angioplasty with platelet IIb/IIIa receptor blockade. Comparison of transradial vs. transfemoral arterial access. Eur Heart J. 2000;21:662-7.

Shoulders-Odom B. Management of patients after percutaneous coronary interventions. Crit Care Nurse. 2008;28:26-42.

Dumont CJ, Keeling AW, Bourguignon C, Sarembock IJ, Turner M. Predictors of vascular complications post diagnostic cardiac catheterization and percutaneous interventions. Dimens Crit Care Nurs. 2006;25(3):137-42.

Dressler D, Dressler K. Caring for Patients with Femoral Sheaths: After percutaneous coronary intervention, sheath removal and site monitoring are the nurse’s responsibility. Am J Ng. 2006;106(5):64A-64H.

Ertin H, Uzun Ö, Kurnaz G. Notify patients about diagnostic operations to be applied to the level of anxiety of influence will be measured and evaluated. In: Ertin H, Uzun Ö, Kurnaz G, eds. I. National Medical Ethics Congress Abstract Book. Kocaeli: NMECAB; 1999: 43-47.

Sunbul M, Bozkurt Zincir S, Durmus E, Aydin Sunbul E, Cengiz FF, Kivrak T, et al. Anxiety and depression in patients with coronary artery disease. Bull Clin Psychopharmacol. 2013;23(4):345-52.

Vural M, Satiroglu O, Akbas B, Goksel I, Karabay O. Coronary artery diseasein association with depression or anxiety among patients undergoing angiography to ınvestigate chest pain. Tex Heart Inst J. 2009;36(1):17-23.

Tajfard M, Ghayour-Mobarhan M, Rahimi HR, Mouhebati M, Esmaeily H, Ferns GAA, et al. Anxiety, depression and coronary artery disease among patients undergoing angiography in Ghaem Hospital, Mashhad, Iran. Health. 2014;6:1108-15.

Baram Z. Evaluation of anxiety of patients to coronary angiography. In: Baram Z, eds. Master’s Thesis. İstanbul: İstanbul University Institute of Medical Sciences; 1993.

Karadede AA, Temamoğulları AV, Altındağ A, Ülgen S, İltümür K, Toprak N. The relation between the number and severity of coronary artery stenosis and tendency to depression and anxiety. Turkiye Klinikleri J Cardiol. 2001;14(2):98-103.

Chair SY, Yu M, Choi KC, Wong EML, Sit JWH, Ip WY. Effect of early ambulation after transfemoral cardiac catheterization in Hong Kong: a single-blinded randomized controlled trial. Anatol J Cardiol. 2012;12(3):222-30.

Bloodworth D, Calvillo O, Smith K, Grabois M. Chronic pain syndromes: evaluation and treatment. In: Bloodworth D, Calvillo O, Smith K, Grabois M, eds. Physical Medicine and Rehabilitation. 3rd ed. Philadelphia: WB Saunders; 2000:913-933.

Puntillo K, Weiss SJ. Pain its Mediators and associated morbidity in critical ill cardiovascular surgical patients. Nurs Res. 1994;43(1):31-5.

Kocaman G, Karayurt Ö, Özmen D. In-service training of nurses in pain control behaviors investigation of the effects. In: Kocaman G, Karayurt Ö, Özmen D, eds. III. Nursing Education Symposium. İstanbul: NES; 1993.

Büyükyılmaz F, Aştı T. Postoperative pain diagnostics in orthopedics and traumatology patients. In: Büyükyılmaz F, Aştı T, eds. Master’s Thesis, İstanbul: İstanbul University Institue of Medical Sciences; 2005.