With the rapid socio-economic development, the pace of life is obviously accelerated, the increasingly fierce social competition, the subhealthy people are increasing day by day, excessive psychological load or social pressure often lead to a variety of psychological disorders and physical disorders. The viewpoint of psychosomatic medicine shows that: certain psychological and emotional activities are closely related to certain physical and physiological activities, and strong and persistent adverse emotions can lead to physical diseases, thus emphasizing the role of psychological and social factors in the occurrence of human diseases. Common diseases of the cardiovascular system such as hypertension, coronary heart disease and arrhythmia are psychosomatic diseases. Anxiety and depression disorders are the most common psychological disorders in general hospitals and are closely related to various cardiovascular diseases. Data show that the incidence of psychological disorders in outpatients of Shanghai general hospitals in the 1990s was 10% ~ 20%, and 20% ~ 50% for inpatients, of which 40% ~ 50% were cardiovascular diseases, mainly anxiety disorders and depression disorders. Since the Department of Cardiology of Beijing Military General Hospital launched the “Double Heart Clinic”, the statistics of outpatients with anxiety disorders, including generalized anxiety and medical anxiety, accounted for about 20% ~ 30%, depression disorders accounted for about 15% ~ 20%, and somatoform disorders accounted for about 10% ~ 20%. At present, clinicians in domestic general hospitals generally have a very low recognition rate of anxiety and depression disorders, resulting in these patients often do not get the correct diagnosis and treatment, and as a result, repeated medical treatment, resulting in a serious waste of medical resources, therefore, it is very important for clinicians in general hospitals to improve the ability to recognize psychological disorders. 1, the clinical manifestations of anxiety and depressive disorders in the cardiovascular department The most common complaints of patients with depressive disorders in the cardiology department are tightness in the chest, panic, shortness of breath, and the symptoms are alleviated or comforted after long out of breath, and the electrocardiogram has no obvious ischemia or arrhythmia changes, or the changes are not enough to explain the patients’ persistent or severe symptoms; some of the patients complained of chest pain, which may be accompanied with shoulder and back pain, and the pain tends to be irregular and not very much related to the labor, and the pain may be caused by nitrates, which are not very important for the patients. The pain is often irregular and not related to exertion, and the relief is slow after taking nitrate drugs; these patients often seek multiple doctors or go to multiple hospitals to receive multiple electrocardiograms, and many of them have also had active plate, cardiac ultrasound, and ambulatory electrocardiograms, which did not show any obvious abnormality, and they are also taking various drugs for treating coronary artery disease, but the effect is not obvious; some of the patients have also received coronary artery angiograms, which ruled out coronary artery disease, and finally They also left the matter unsettled, or continued to use some anti-angina drugs. Because the patients’ pain experience is not relieved, they are always in a constant state of seeking medical treatment. Other common complaints include: ① fatigue, loss of energy, loss of interest. Patients often say that they don’t want to do anything, or want to do things but can’t do it, no spirit, the things that they used to like to do now don’t love to do or can’t do it; ② sleep disorders, such as difficulty in falling asleep, waking up early or too much sleep; ③ loss of appetite, eat nothing taste, weight loss; ④ mood, easy to sulk, often because of a little thing with other people or with their own, and after the regret and self-accusation, and even often feel guilty; ⑤ brain power, easy to sulk, often with others or with themselves, and even after the regret and blame, often Feeling guilty; ⑤ slow brain power, memory loss; ⑥ pessimism, feeling worthless, always saying or thinking “What’s the point of living? It is better to die than to live”. Some patients have even made preparations for suicide; (7) loss or even total absence of libido. The last four items often require the doctor to take the initiative to ask questions. The most common manifestations of anxiety disorders in the cardiology department is chest pain, chest pain is mostly pins and needles, occurring in quiet, no relationship with exertion, some relieved after the activity, nitrate drugs relief is not obvious, the electrocardiogram does not have a significant ischemic changes, while there is excessive worry, nervousness and anxiety, often accompanied by sleep disorders, autonomic hyperfunction manifestations, such as sweating, redness, panic, shortness of breath, and dizziness, hand tremors, Nausea, bowel sounds, frequent urination, pain and other systemic manifestations of anxiety. Unlike depressive disorders, patients with anxiety disorders have many complaints involving multiple systems and organs, and as long as the doctor is able to listen patiently, the patient can often take the initiative to speak out. Depressive disorder patients can be accompanied by obvious anxiety manifestations, such as the simultaneous presence of anxiety and depressive symptoms, to diagnose depressive disorder, especially in the elderly, depressive disorder is easy to be masked by anxiety manifestations. The relationship between anxiety and depression disorders and cardiovascular diseases 2. 1, anxiety and depression disorders are easily misdiagnosed as cardiovascular diseases Acute anxiety attacks – panic disorder can be manifested as a sudden onset of palpitations, chest tightness, dyspnea with sweating and other manifestations, accompanied by a strong sense of panic, a sense of imminent death, and in some cases, night attacks, in addition to the above symptoms, there are forced to sit up, asking for inhalation. In addition to the above symptoms, there are also forced to sit up, demand for oxygen and other symptoms similar to acute left heart failure, tachycardia during the attack, often consult the emergency department of the hospital, the symptoms are heavy, it is easy to be misdiagnosed as acute coronary syndromes or acute left heart failure attack. Overseas literature reports that more than 50% of patients with chest pain attending the emergency department are non-cardiac, of which 16% ~ 25% are panic attacks. Panic attacks also occur in up to 31% ~ 56% of cardiology patients. Patients with chronic anxiety or depressive disorders often consult the cardiology department due to symptoms such as chest pain, chest tightness, and shortness of breath, which can easily be misdiagnosed as coronary artery disease and angina. Many clinicians do not dare to rule out cardiopulmonary diseases because they do not recognize psychological disorders, and prescribe a variety of cardiac and pulmonary tests to patients, including cardiac ultrasound, active plate, dynamic electrocardiogram, chest radiograph or CT, and even coronary angiography. In the case that the tests do not support cardiopulmonary diseases, doctors can often only tell patients that they cannot diagnose heart disease or pulmonary disorders, but they are still unable to do anything about the various symptoms of patients. In fact, as long as the clinician understands the anxiety and depression disorders, by asking the medical history, can completely avoid all kinds of unnecessary tests, at the same time, give the patient with the appropriate anti-anxiety and antidepressant drugs, the patient’s symptoms can be relieved very quickly. 2. 2. Anxiety and depression are risk factors for cardiovascular diseases According to a survey, among people with depression and anxiety disorders, the incidence of hypertension increases twofold, the risk of stroke, angina pectoris and myocardial infarction increases sixfold, and the mortality rate increases more than twofold. The reasons are considered as follows: (1) depressive disorders and anxiety disorders may reduce heart rate variability, thus increasing the risk of cardiovascular events; (2) elevated sympathetic tone in depressed patients may cause increased myocardial oxygen consumption; (3) increased catecholamines, cellular intermediates such as interleukin-2 (which can lead to depression), and tumor necrosis factor in the blood of patients with depressive disorders, which may result in toxic side effects on the myocardium; (4) increased platelet activity in patients with depressed disorders, which may cause increased blood viscosity and increased risk of thrombosis; ⑤ depressed patients have more smokers, which may cause coronary artery spasm and myocardial ischemia. 2. 3, cardiovascular disease is easy to secondary depression many chronic diseases combined with anxiety and depression disorder, cardiovascular disease anxiety and depression disorder combined rate is very high. Domestic and foreign literature reports, after myocardial infarction patients with depression disorder incidence rate of 35% ~ 45%, of which 15% ~ 20% severe depression; unstable angina patients with depression incidence rate of 41%, severe depression accounted for 15%; congestive heart failure patients with depression incidence rate of 35%, of which 14% severe depression; CABG patients with preoperative depression incidence rate of 43%; patients with coronary heart disease, the co-morbidity of panic disorder In patients with coronary artery disease, the prevalence of panic disorder is 6.5% to 53%; in hospitalized patients with coronary artery disease and acute myocardial infarction, 69% of them have a combination of anxiety symptoms; and 50% of patients hospitalized in CCU have a combination of anxiety. Hypertensive disease and cardiac arrhythmia combined anxiety and depression disorder is also as high as 30% ~ 50%. The effects of anxiety and depression on cardiovascular disease are mainly manifested in the following aspects: 1) affecting the patient’s adherence to treatment. Patients with anxiety and depression disorders often have poor treatment compliance and cannot cooperate well with the doctor’s treatment, resulting in reduced efficacy and prolonged treatment; ② affect the patient’s prognosis. Depressive disorder is an independent risk factor for cardiovascular disease, independent of its underlying cause, cardiovascular disease combined with depressive disorder patients with high mortality and re-hospitalization rate, the prognosis is not good; ③ affect the quality of life of patients. Anxiety and depressive disorders cause a further decline in the health status of patients with cardiovascular disease and a further reduction in quality of life, including somatic abilities and social functioning; ④ Increase healthcare costs. Patients with comorbid anxiety or depressive disorders have significantly higher medical costs due to repeated visits to the doctor or hospitalization and prolonged hospitalization, which increases the socioeconomic burden. For example, in an acute myocardial infarction combined with mild-to-moderate depressive disorder follow-up, compared with non-depressed patients, depressed patients with one year of medical costs 42% higher. 4, the treatment of anxiety and depressive disorders 4. 1, drug treatment Patients diagnosed with anxiety or depressive disorders should be given anti-anxiety and antidepressant drug therapy, selective 5-hydroxytryptamine reuptake inhibitors (SSRIs) are easy to use, with fewer adverse effects, and at the same time, have obvious antidepressant and anti-anxiety effects, and should be the first choice, especially sertraline hydrochloride (Zoloft), cetaplan (cipramil) after the use of fewer adverse effects, fewer interactions with other drugs, and fewer interactions with other drugs, and fewer interactions with other drugs. The former has been proven to be safe and effective in cardiovascular patients in large-scale clinical trials, but for patients taking warfarin anticoagulation, it should be noted that the drug will compete with warfarin for plasma proteins, leading to an increase in the latter’s blood concentration, so the INR must be closely monitored when the two drugs are used together. At the same time, patients should be informed of the onset of action, possible adverse reactions, duration of treatment and other precautions, so as to avoid patients casually stopping the drug. 4.2 Psychotherapy Assess the role of patients’ psychosocial factors in the development of the disease; for patients with obvious psychosocial factors, combining psychotherapy with drug treatment to relieve their psychological conflicts can significantly enhance the efficacy of treatment and avoid relapse. Cognitive behavioral therapy is the preferred psychotherapy for patients with anxiety and depression disorders. 4. 3, attention to the problem of anxiety and depression to the general hospital patients are mostly mild to moderate patients, with physical symptoms as the main clinical manifestations and complaints, the treatment of attention to the following points: (1) patience, listening, appropriate inquiry. To give patients a certain amount of time to talk about the discomfort of the symptoms out; the doctor’s sincere attitude and patience to listen to itself can play a role in psychotherapy. Depression disorder patients often need to take the initiative to ask, in order to ask a variety of symptoms. (2) Explain the condition. First of all, recognize that the patient’s feelings are real, explain to the patient’s condition, eliminate or alleviate the patient’s concerns about heart disease, and tell him or her the main cause of the current discomfort, that is, a kind of disease known as “anxiety disorders or depressive disorders”, which is mainly caused by neurotransmitter 5-HT, norepinephrine disorders in the brain. Depressed patients should also inform their families of their condition to prevent suicide. (3) Tell the patients about the onset of effect of the drugs and the possible adverse effects, so as to avoid the patients from stopping the drugs casually. (4) For patients with serious anxiety and depression, it is recommended that they go to a specialist or specialized psychiatric hospital for consultation and treatment.