How do you diagnose a patient with psychological heart disease? Primarily, we have to do two things: first, complete a screening for organic disease of the heart; second, complete a corresponding psychosomatic and even emotional stress assessment. Only then can we determine whether there is a cardiac or psychological problem in the patient and whether there is a correlation between the two. Generally speaking, when patients come to the outpatient clinic, they will first undergo an electrocardiogram and cardiac ultrasound; after that, they may undergo an ambulatory electrocardiogram to check whether the patient has myocardial ischemia at night or during exercise; they may also undergo an exercise plate test to find out at what level of exercise the patient has myocardial ischemia; if the exercise plate test is positive, they may also undergo a coronary CT or angiography to see whether there is a blood vessel If the exercise plate test is positive, a coronary CT or angiogram may be performed to see if there is a blockage. When this series of tests is done, the doctor will have a general grasp of the patient’s heart condition. After that, the doctor will assess the patient’s mental and psychological problems, such as asking the patient, “Has anything special happened recently,” “Is there a lot of stress at work,” “Do you have a habit of staying up late? ” “How is the state of life”, etc. The doctor will initially understand the patient’s regular status, and after that, delve deeper into his mental stress problem. Next, the patient may need to do some assessments, such as those for depression, anxiety and other mental problems. Through these methods, the doctor can basically determine the patient’s mental, psychological or emotional state. Are all patients with psychological heart disease accompanied by emotional problems such as anxiety and insomnia? Most do, but some may have typical psychological problems, some may not, some have obvious symptoms, and some have insidious symptoms. We meet a lot of patients who seem very sunny and cheerful, and I ask them, “Are you ever in a bad mood, are you unhappy?” They say, “No, I’m happy all day long.” In fact, as we gradually screen, we find that these patients have insidious depression, also called masked depression, where they look happy while inside they are sad, only the sadness doesn’t show up as easily. This requires careful identification and diagnosis by the physician.