Cardiophobia
| Classification according to ICD-10 | |
|---|---|
| F45.0 | Somatization disorder |
| F45.2 | Hypochondriac disorder - heart anxiety |
| F45.3 | Somatoform autonomic dysfunction - cardiac neurosis |
| ICD-10 online (WHO version 2019) | |
Under Da Costa's syndrome (also Da Costa's syndrome , syn. Heart anxiety , heart phobia , cardiac neurosis , Da Costa's syndrome or effort syndrome ) is the fear of suffering from a threatening heart disease or suffering a heart attack. This fear is accompanied by a variety of functional disorders of the cardiovascular and respiratory systems.
The cardio phobia is a variant of the group of hypochondriacal disorders (according to ICD-10 ) or of the panic disorders (according to DSM-V ). It is classified as a somatoform autonomic dysfunction of the cardiovascular system (according to ICD-10).
The symptoms of the vegetative arousal including the attribution of causes by the person affected are assigned to an organ system (here the heart). In the absence of an underlying physical illness, attacks of elementary anxiety occur in which the patient fears immediate cardiac arrest and death. The onset is often like a sympathicovascular attack.
Heart phobics often have a doctor odyssey with many different examinations ( resting ECG , stress ECG , cardiac catheter, etc.) behind them, but in most cases no organic causes for a heart disease are found. Only high or low blood pressure and / or a fast pulse are diagnosed. Even with physical well-being, thoughts and attention revolve around the autonomous and normally unnoticed activity of the heart. Every heart attack, every "heart stumble", every pain in the chest is felt to be very uncomfortable. A social heart attack or a television report of heart disease can trigger various symptoms of heart disease.
Fear of cardiac arrest or a heart attack leads to palpitations and / or fluctuating blood pressure. Symptoms and fear reactions rock each other up and can therefore lead to acute fear of death. Over time, "fear of fear" ( phobophobia ) can develop. It mainly affects people in their 3rd and 4th decade with a male to female ratio of 3: 2.
Anxious and help-seeking behavior
People with fear of the heart and fearful behavior usually check their pulse and blood pressure frequently. Physical exertion is avoided in order to protect the heart. Your own physical condition is regularly analyzed (am I feeling well at the moment? Is my heart beating regularly? What could this brief tug in the chest mean?). Activities are first checked to see if they could be dangerous to the heart. Routes by car are chosen in such a way that they do not lead through lonely areas and - as far as possible - pass many hospitals or medical practices, so that quick help is guaranteed in an emergency. Driving at night on a motorway, for example, is perceived as very unpleasant, as are holiday destinations with little or no medical care.
People with heart anxiety often carry phone numbers of important doctors, hospitals and emergency numbers with them for safety. In the social environment, people are easily involved in the alleged heart disease. Important people should be available at all times in an emergency.
Over time, television programs or reports of heart disease are either avoided or received with particular interest.
People with heart anxiety are often permanent residents of medical facilities. Internists , cardiologists , neurologists, etc. are visited again and again because the symptoms (palpitations, high blood pressure, etc.) keep recurring. In many cases, those affected feel better in the presence of a doctor.
Avoidance behavior
Does a person with heart anxiety e.g. If, for example, she has a racing heart when going to the cinema, she will probably avoid every cinema in the future. Just the thought of going to the movies can trigger physical symptoms that again resemble heart disease. Over time, all places that were the scene of physical complaints and are therefore fearful are consistently avoided. Places that make quick help in an emergency impossible can also be fearful. Therefore, over time and the greater the “fear of fear”, these places are also avoided. The result is often social isolation and isolation. Over time, these people find it increasingly difficult to cope with everyday life. Physical exertion is avoided.
The fear of fear
People with fear of the heart develop fear of fear ( phobophobia ) very quickly . Through careful introspection, concern for the heart, and fear of suffering from heart disease, the body is in a constant state of alarm, even if the person is not aware of it. Even small things (a loud bang, a cold, nervous tension, etc.) are enough to set the cycle of fear in motion. Physical symptoms occur that are perceived as threatening and trigger fear or panic. Anxiety and panic make the symptoms worse.
Fear of the heart can trigger panic attacks , but panic attacks can also manifest themselves in a heart phobia.
Symptoms
- profuse sweating, often all over the body
- Tachycardia , heart attacks, cardiac arrhythmias ("heart stumbling" and "dropouts")
- Fear of death
- Short-term high blood pressure, very high pulse, tremors in the hands
- Nausea, dizziness, "weak knees", shortness of breath, hyperventilation
- Pain in the heart and chest, often radiating to the left arm or even the back
- Sensation of pressure and / or tightness in the chest, the feeling that a steel clamp has wrapped itself around the entire chest, also radiating into the throat, lower jaw and stomach
Heart neurotics , in contrast to other phobics, have the problem of not being able to evade their fear, as the object of their fear is their own heart and is not only tied to a special event or place (such as fear of crowds or Fear of altitude).
If heart anxiety is suspected, all possible physical causes must first be ruled out by a cardiologist or internist using a differential diagnosis ( exclusion diagnosis ).
therapy
- In the acute state, being present and talking to a doctor is often enough to provide sedation. Otherwise, tranquilizers (but only temporarily due to the risk of addiction and if the symptoms are very pronounced) or beta-blockers are indicated. Neuroleptics and antidepressants , which can increase heart rate and thus anxiety, are not appropriate.
- However, it is crucial to start psychotherapy as quickly as possible . Behavioral therapy in heart phobias has proven particularly effective here. Dealing with the cause and the conflict situation immediately after the first attack of anxiety can in some cases hold back further phobic development. Treatment later is more difficult and time consuming.
Individual evidence
- ^ Wilhelm Nonnenbruch : Diseases of the circulatory system , in: Textbook of internal medicine, 4th edition, Springer-Verlag, 2 volumes, volume 1, Berlin 1939, pp. 421-425.
- ↑ Named after Jacob Mendes Da Costa (1833–1900), cardiorespiratory symptom complex with psychogenic heart pain; see. Günter Thiele (editor): Handlexikon der Medizin , Urban & Schwarzenberg , Munich / Vienna / Baltimore 1980, Volume 1, Page 453.
- ^ HH Studt, ER Petzold: Psychotherapeutic Medicine. Psychoanalysis - Psychosomatics - Psychotherapy. A guide for clinic and practice. de Gruyter, p. 129.
- ^ A b Hans Morschitzky : Somatoform disorders. Diagnostics, concepts and therapy for body symptoms without organ findings. 2nd Edition. Springer Verlag, Vienna / New York 2008, p. 107 ff.
- ↑ ICD-10: F45.3 Somatoform autonomic dysfunction
- ^ Wielant Machleidt, Manfred Bauer, Friedhelm Lamprecht, Hans K. Rose, Christa Rohde-Dachser : Psychiatry, Psychosomatics and Psychotherapy. 7th edition. Thieme, 2004, p. 130.
- ^ A b Rainer Tölle: Psychiatry. 7th edition. Springer Verlag, Berlin / Heidelberg / New York / Tokyo 1985, p. 76.
- ↑ Buchta, Höper, Sönnichsen: The second StEx. Basic knowledge of clinical medicine for exams and practice. 2nd Edition. Springer, Cologne, 2004, p. 273.
- ↑ Erland Erdmann : Clinical Cardiology. Diseases of the heart, the circulatory system and the vessels near the heart. 7th edition. Springer Verlag, 2008, p. 486.
