Cardiophobia – pathological fear of death for a heart disease. The patient suspects at himself heavy cardiac pathology, treats any feelings (single ekstrasistola, increase of breath and heartbeat after physical activity, intercostal neuralgia) as a sign of the coming accident. All life of the patient concentrates around inspections, treatment and observations of activity of the organism. The diagnosis is exposed on the basis of complaints, the anamnesis of a disease yielded survey and results of additional researches. Treatment – psychotherapy, if necessary against the background of medicamentous support.
Cardiophobia – persuasive fear of death for a heart trouble. Is one of the most widespread nozofobiya along with a kantserofobiya. Statistical data differ, however experts note that about 15% of patients of cardiological offices are made by patients with functional frustration of cardiovascular system (cardioneurosises, a kardialgiya and a cardiophobia). The cardiophobia can arise as at people with healthy cardiovascular system, and at the patients having heart diseases. In the second case bright discrepancy between expressiveness of clinical symptoms and emotional reactions is observed. Treatment of a cardiophobia is performed by experts in the field of psychotherapy and clinical psychology.
Reasons and mechanism of development of a cardiophobia
The increased uneasiness and/or excessive long psychological tension is the main reason for development of a cardiophobia. It is established that the disease arises at diffident, emotionally unstable disturbing persons more often, at patients with a hysterical warehouse of character and at active people of sanguine temperament who have tendency to exaggerate the importance of own purposes, are not able to relax and distract from useful activity even in free time.
The obvious or implicit stressful situation becomes a push for development of a cardiophobia. At some patients the first symptoms of a cardiophobia arise after detection of a serious heart disease at the relative, close contact with the patient having heavy cardiac pathology or news of the death of the acquaintance from a heart trouble. Especially bright impression is usually made a story about sudden "cardiac rupture" at earlier healthy people of young and middle age.
In some cases the first signs of a cardiophobia appear against the background of planned professional survey or inspection concerning other (not cardiac) disease. The patient learns about small deviations in work of cardiovascular system or incorrectly treats the harmless phrase of the doctor and forms a picture of awful death from a heart trouble. Sometimes patients with a cardiophobia really have some cardiovascular disease, however their fear does not correspond to a real situation, and their experiences on force and intensity are incomparable to usual human experiences.
In all cases the internal concern, the obvious or hidden feeling of own helplessness, inability to cope with vital circumstances becomes a basis for development of a cardiophobia and to control the world around in that degree in which it is required to the patient with a cardiophobia. The non-local alarm looks for an exit, the patient begins to listen excessively to the feelings, and localization of fear at the initial stage in some sense even gives relief – now, in any case, clear that occurs and that needs to be done (to ask for the help, to be treated, escape).
However soon the cardiophobia, as well as other similar frustration, itself becomes the reason of new problems. The patient as if gets to alternative reality where there is even not a threat of life, and direct feeling of inevitably coming death which is not able to dispel either data of inspections, or logical arguments. There is a vicious circle, a sick cardiophobia for years can move from doubts to despair, from alarm – to hope while real life falls into decay and passes by.
The clinical picture of a cardiophobia is very diverse, however from this variety it is possible to allocate three main forms of a course of disease: pseudo-rheumatic, psevdoinfarktny and neurotic. The pseudo-rheumatic form of a cardiophobia on the symptoms reminds rheumatic heart disease. At patients chronic tonsillitis often comes to light. Patients show complaints to heartbeat, short wind and pains in heart. The periodic unsharply expressed joint pains are often observed. Symptoms amplify against the background of physical activity.
The rheumatic disease of the close relative or inspection in office of cardiology or rheumatology concerning insignificant functional violations (changes on the ECG, temperature increase) becomes a push to development of a cardiophobia usually. Having seen enough of the real patients, the patient finds at himself everything (or the majority) symptoms, persistence shows and tries to obtain performing antirheumatic treatment. Treatment, naturally, is inefficient, and the patient is convinced that his state is hopeless.
The Psevdoinfarktny form of a cardiophobia usually arises at the patients possessing certain knowledge of the field of medicine: health workers, people of other specialties working in medical institutions (accountants, representatives of economic services), the people who are interested in health issues and national methods of treatment. The fear of a myocardial infarction appears after insignificant pain in heart, all thoughts of the patient with a cardiophobia concentrate around an estimated new attack and almost inevitable death following it.
The patient begins to be examined and treated actively, attacks repeat (usually they are caused by cervical osteochondrosis, intercostal neuralgia, functional violations in work of heart in the climacteric period etc.), nitroglycerine and other cardiacs do not help. Results of inspections do not show any pathology or demonstrate insignificant violations, however for the patient captured by fear it looks unconvincingly. The patient, as well as at a pseudo-rheumatic form, draws a conclusion about hopelessness of the state.
Uncertainty of clinical manifestations is characteristic of a neurotic form of a cardiophobia. Patients speak about pressure in a breast, unusually loud heartbeat, "feeling of heart" and dissatisfaction with a breath. Complaints of patients do not keep within a picture of any heart disease. Sometimes this option of a cardiophobia long time proceeds without attacks, however, life of patients at a neurotic form of a disease is limited not less, than at psevdoinfarktny or pseudo-rheumatic. Patients are afraid to move, are afraid to remain alone or to walk the streets without guides. Some spend years to beds, being incessantly tormented with fear for the life.
In the period of an attack of a cardiophobia the characteristic clinical picture is observed: patients are noncritical and excessively concentrated on the feelings, they rush about in a bed. After assurances about safety of their state and request to calm down they for several minutes calm down, but then come back to former behavior. Duration of an attack can make from several minutes to several days. Upon termination of an attack the patients suffering from a cardiophobia continue to feel concern about the state. They constantly consider pulse and measure arterial pressure, are fixed on any changes of health and treat them in a negative key.
Other aspects of life become unimportant, little significant. Patients with a cardiophobia give up work, shift all household chores to shoulders of relatives, stop leading sex life and avoid any disorders (ask not to tell about something concerning and terrible, choose the movies and books which are not touching feelings and not causing deep experiences, refuse to be present at a funeral). They extremely strictly observe a day regimen, "keep" the rigid diet, try not to go outside once again, constantly read specialized and popular medical literature. Often patients avoid to sleep on the left side and suffer from sleeplessness because they are afraid to die in a dream.
Diagnostics and treatment of a cardiophobia
The cardiophobia is diagnosed on the basis of complaints of the patient and history of a disease. For an exception of cardiac pathology conduct the examination including consultation of the cardiologist, consultation of the rheumatologist, rheumatic tests, the ECG and ultrasonography of heart. If necessary appoint a veloergometriya, a stress echocardiography and other researches. Existence of cardiac pathology does not exclude a cardiophobia, in this case the diagnosis is exposed taking into account discrepancy of complaints and experiences of the patient to a clinical picture and data of objective researches.
Treatment of a cardiophobia is usually performed in out-patient conditions. At strong indications of a decompensation hospitalization in office of neurosises is possible. At the expressed concern, sleeplessness and affective violations appoint soothing and antidepressants. Carry out the psychotherapy directed to identification of the real reasons for the increased uneasiness, help patients with a cardiophobia to work the intra personal conflicts and to develop new, healthier and adaptive ways of response to acute and chronic stress. At timely treatment the forecast favorable.