Cardiac neurosis

Sophie Matzik is a freelance writer for the medical team.

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Heart neurosis is a mental disorder. Those affected repeatedly complain of heart problems, but these cannot be traced back to any organic cause. Many patients live in fear of suffering a heart attack. There are panic attacks, fear of death and, not infrequently, complete social withdrawal. Read here what causes a heart neurosis can have and how it is treated.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. F40

Cardiac neurosis: description

Heart neurosis is a mental illness. It has numerous other names, such as heart phobia, heart anxiety, cardiophobia or Da Costa syndrome. Sufferers complain of various heart problems and are usually convinced that they have heart disease. They also often live in constant fear of having a heart attack. This fear triggers or increases further or renewed physical complaints such as palpitations, heart pains or heart palpitations. The heart neurosis affects the entire life of those affected. It is not infrequently accompanied by panic attacks or a downright fear of death.

It is fundamental for the diagnosis of a heart neurosis that a heart specialist (cardiologist) cannot determine a physical cause of the symptoms. Doctors then refer to these as functional complaints. Therefore the heart neurosis or heart anxiety belongs to the somatoform, autonomous functional disorders. This means that the physical complaints of the heart neurosis have no physical cause, but are psychological. It is not uncommon for those affected to get caught in a vicious circle of fear and physical symptoms that they can no longer break through on their own.

It is important to note that a heart neurosis can develop into an actual heart disease over time. A heart neurosis can also be an accompanying symptom of a physical illness. For example, people who have had a heart attack very often develop a heart neurosis in fear of another heart attack.

Cardiac neurosis: frequency

In Germany around 100,000 people suffer from heart anxiety. About 15 percent of all patients who see a doctor about heart disorders have a heart neurosis; often it is men. Heart neurosis occurs especially in those over 40 years of age. Younger people rarely suffer from it.

Cardiac neurosis: symptoms

An important symptom of a cardiac neurosis is, on the one hand, the fear of heart disease, which the person concerned is constantly with. This fear can become so strong that it leads to panic attacks and fear of death.

On the other hand, those affected are convinced that they actually suffer from heart disease. In addition, patients are very focused on their bodies. Even slight signs, such as a naturally occurring additional heartbeat (extrasystole), are interpreted as life-threatening illnesses.

In anxiety states, the person's pulse accelerates and blood pressure rises. This can be accompanied by palpitations, heart pains or palpitations. It can also cause dizziness, shortness of breath, sweating and tremors. Patients usually complain of several alternating symptoms.

If these symptoms only occur in the context of an anxiety or panic disorder, it is not a cardiac neurosis!

The symptoms of a heart neurosis can also spread to other organ systems: digestive problems and stomach pain are typical. Sleep disorders are also a frequent accompanying symptom of the heart neurosis.

Social withdrawal

A heart neurosis is above all a psychological problem, so those affected also suffer emotionally. It outweighs most other sensations in everyday life. Those affected suffer from inner restlessness, live in a constant relieving posture and often show depressive symptoms. You may also try to avoid any physical exertion, excitement, or stress out of fear and belief that doing so will result in a heart attack.

Usually the social environment such as family or work colleagues is also included. Affected people believe that they cannot survive on their own. Many lose all confidence in their abilities and strengths. Relatives and friends often do not know how to behave properly.

Anyone who suffers from a heart neurosis, despite all the attention that is given to them, feels misunderstood most of the time and is convinced that no one, not even a doctor, can help them.

As a result, many of those affected withdraw by themselves. Sometimes friends turn more and more away from the person affected out of helplessness and helplessness. The social loneliness increases the symptoms of the cardiac neurosis again.

Cardiac neurosis: causes and risk factors

Heart neurosis is a psychosomatic illness. This means that the symptoms that occur do not have a physical cause, but a psychological one.

There are several theories as to where to look for the causes of a heart neurosis:

• Causes in childhood: The specialist literature often describes a disturbed relationship between parents and their child as a risk factor for cardiac neurosis later in life. Different types of relationships can play a role: Mothers are often described as overprotective and too dominant. Likewise, an early separation or neglect can also be the reason for the disorder, in which children have no opportunity to learn coping strategies.
• Illnesses in the social environment: Scientists assume that the risk of a heart neurosis is higher if a close relative or a close friend has already suffered from a heart neurosis or actual heart problems. In this way, the fearful handling of the heart is exemplified in the environment and taken over by those affected.
• Deaths: Deaths in one's own environment can also cause a heart neurosis. The death of a relative or acquaintance makes those affected aware of their own mortality. Many fear death and react to this fear with excessive caution and the belief that they will in fact die soon.
• Conflicts and problems: Unresolved problems and conflicts in everyday life can also contribute to the development of cardiac neurosis. They affect the heart's function in a normal way: the heart beats faster. This reaction is often misinterpreted and interpreted as a serious illness. The other conflicts then also take a back seat.
• Previous illnesses: The heart neurosis can also be a result of a previous illness. For example, people who have had a heart attack often develop an overwhelming fear of having another heart attack.

How does a heart neurosis develop?

All of these theories have one thing in common: people with cardiac neurosis are usually very sensitive, insecure and have little self-confidence. They often misinterpret a perfectly normal reaction of the heart and interpret it as a sign of a serious illness. The heart reacts very sensitively to all mental changes: For example, it starts beating faster than usual when there is fear, stress or problems in everyday life. Often one sweats more or begins to shiver.

With a heart neurosis, these symptoms are overrated. As a result, those affected begin to pay more attention than any other person to changes in their body. This leads to a vicious circle of wrongly interpreted heart actions that can no longer be broken alone.

Physical requirements

Most of those affected also have certain physical conditions that favor the development of a heart neurosis. While other people develop stomach problems, migraines or sleep disorders under stress and strain, people with a heart neurosis react with heart problems.

Cardiac neurosis: examinations and diagnosis

The diagnosis of cardiac neurosis is very difficult and can take many years. Those affected assume that their symptoms have a physical and thus a verifiable cause. In fact, the cause of the cardiac neurosis lies in the psyche and can therefore not be proven with imaging or measurement methods. Nevertheless, in order to clarify a heart neurosis, a physical cause of the problem must be ruled out by means of examinations.

Physical examination

During the physical examination, a resting and an exercise ECG are usually made first. These examinations are painless for the patient. With their help, heart activity is recorded. For example, cardiac arrhythmias can be clearly recognized.

A blood test is also done when a heart neurosis is clarified.

If these initial examinations do not reveal any malfunctions, more complex examinations such as a cardiac catheter examination, magnetic resonance imaging (MRI) or cardiac ultrasound can be used.

If, in all of these examinations, the doctors do not find any organic cause for the symptoms, the suspicion that there is a psychological cause and thus a heart neurosis is reinforced.A detailed discussion with the patient provides crucial information for the diagnosis. A psychiatrist or psychologist is usually consulted for this.

Initial psychiatric consultation

People with cardiac neurosis are strongly focused on their own heart and their fear of the disease. She feels very stressed by her symptoms. Sometimes those affected report a specific fear, for example of a heart attack, shortness of breath or death. In some cases, the issue of fear is not so clearly tangible.

It is also typical of cardiac neurosis that those affected like to tell a lot about themselves and report in detail about their complaints. The symptoms are not necessarily limited to the heart, either. Problems with digestion, stomach or sleep disorders can also burden those affected. Previous psychological complaints are also frequently reported.

If the diagnosis goes on for many years, a change from "good" and "bad" times becomes clear for most of those affected. During normal everyday life or when other problems, for example at work, pile up, the heart problems usually also worsen. On the other hand, those affected are usually much better off on vacation. Very rapid mood changes can also occur.

trouble

A heart neurosis can be an accompanying symptom of an actual heart disease. Likewise, in patients who initially have no organic complaints, a heart neurosis can develop into an organic disease.

There is also another difficulty: the majority of patients strictly reject the idea that their complaints could have a psychological cause and insist on an organic cause. However, if the physical examination does not provide an explanation, those affected quickly lose confidence in their doctor and see other doctors. They are accompanied by the feeling that they are being misunderstood by the whole world and that they are not receiving enough attention - typical signs of a heart neurosis. Fear of dealing with the real problems can also play a role.

Cardiac neurosis: treatment

Since a heart neurosis is psychologically conditioned, its treatment belongs in the hands of a psychiatrist, a psychotherapist or a doctor specializing in psychosomatic medicine and psychotherapy.

The first step in cardiac neurosis treatment is taken by a general practitioner or a specialist in heart disease (cardiologist). After he has been able to rule out a physical cause of the symptoms, he must carefully familiarize the person concerned with the thought of a psychological cause. Since those affected often vehemently deny this and insist on an organic cause, clarification can take many weeks or even years. Patients who feel misunderstood often switch doctors. Then all examinations are repeated and the start of treatment is delayed again. It is important that the doctor takes the patient seriously and does not dismiss the symptoms as imagination. In-depth discussions about the frequency, consequences, course and background of a cardiac neurosis are helpful.

Improvement of symptoms

Next, the attending physician takes care of improving the symptoms of the heart neurosis, such as palpitations. This includes teaching relaxation techniques (such as progressive muscle relaxation, autogenic training), strategies for coping with illnesses and favorable behaviors that the person concerned can use when (alleged) heart problems arise.

Treatment of the underlying problems

The treatment of cardiac neurosis is based on psychotherapy. It is important to make it clear to those affected that the symptoms that occur may well be there, but are not physical and are usually harmless.

Depending on the patient's problem and personality, there are two options to choose from: cognitive behavioral therapy and psychodynamic therapies such as psychoanalysis. A mixed form with elements of both is also possible.

As part of cognitive behavioral therapy, people with cardiac neurosis learn strategies on how to behave in the event of heart problems. Movement therapy elements are particularly important: those affected experience on their own body that their heart can cope with physical exertion without being damaged. It also includes returning to normal everyday life with light sports such as jogging, walking or swimming. In this way, confidence in your own body is regained and you learn to cope better with fears. The fear of a heart attack disappears and the patient trusts himself more - physically and mentally.

Psychodynamic methods are based on the patient recognizing the role his personal history and important caregivers played in the development of the heart neurosis. The processing of such experiences and the gain in mental stability and self-confidence can enable him to overcome the symptoms.

Medical therapy

At the beginning of the heart neurosis therapy, the heart complaints can also be treated with medication. Beta blockers (beta blockers) dampen the racing heart. However, they are not suitable in the long term due to various side effects. In some cases, sedatives (tranquilizers) or antidepressants are also prescribed. They are also unsuitable for long-term therapy, as they can be addictive.

Cardiac neurosis: disease course and prognosis

As with most other diseases, the same applies to heart phobia: the earlier the disease is recognized, the better the chances of recovery!

If diagnosed early, cardiac neurosis can often be completely cured with the help of psychotherapy. The therapy can, however, take many years to complete. In addition, it is very rarely the case that a heart neurosis is detected early. It often takes years for those affected to receive the right treatment.

The longer the symptoms of a heart neurosis last, the more likely it is that it will become chronic. This complicates the therapy. A chronic heart neurosis develops in around half of all those affected.

Since a heart neurosis can also develop into an actual heart disease, it is necessary for those affected to undergo regular physical examinations during psychotherapy. Corresponding treatment can be started immediately in the event of organic changes.

Psychotherapeutic measures can also help if someone has suffered from a heart neurosis for many years. Even if the complaints do not go away completely - the person affected can at least develop strategies to deal with the functional complaints and to believe more in their strengths again. This can significantly improve the quality of life of cardiac neurosis patients.

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