Matters of the Heart and Hypochondriacs

“His heart rules his head” is a commonly used phrase usually to imply that a person has more kindness than intelligence. But in literal sense the heart rules the head in all of us. It also rules the other parts of the body as it provides nourishment and keeps the vital organs alive.

The relationship between the emotions and the body is no new discovery and hence the saying “a sound mind in a sound body.” The reaction of the heart to emotional disturbances is obvious to everyone of us.

You are aware of the strong beating of your heart during moments of fear. This is due to the stimulation of part of the nervous system called sympathetic nerves which secretes a chemical called catecholamines which in turn cause palpitations by accelerating the heart rate and raising blood pressure.

In popular belief, the heart is supposed to be the seat of the soul, the fountain of life and the seat of emotions. Hence popular phrases and figures of speech such as “heart and soul.” Therefore the heart as a part of body image enters into symptomatology of many neurotic conditions. So it is not surprising that serious alarm and anxiety is caused when a doctor raises the slightest doubt regarding the integrity of a person’s heart.

Medical men therefore, should be extremely careful when they pass a verdict on a patient’s heart. Once a person has been told that he has a heart ailment any suggestion that the heart is normal even by another more qualified physician will be rejected by some patients.

In view of the key position the heart occupies in our body, the heart may be profoundly influenced by psychological and psychiatric states. There is one disorder that is apparently psychogenic in its origin which continues to disable many young men and women called “irritable heart” (also called effort syndrome, soldiers’ heart, Da Costas‘ syndrome and neurocirculatory asthenia) first described by Da Costa in 1871. In this disorder, the people who are affected are very young males and females usually between the ages of 16 and 25. These patients complain of palpitations, difficulty in breathing, fatigue, sharp left sided chest pain, sweating of palms, headache, dizziness and fainting attacks.

When these healthy young men and women are examined one is unable to find evidence of heart disease. Electrocardiograms, X-rays and other cardiac investigations are normal. Recently we came across a young athlete who had all the above features of cardiac neurosis. Extensive investigations showed no evidence of any heart disease. The patients would not believe that he has no heart disease although four senior physicians and many other doctors who saw him previously had reassured him that he has a normal heart. Recently he was seen by an eminent cardiologist in U.K. who confirmed the diagnosis of cardiac neurosis.

The disease is emotional in origin and fear is the emotion involved. Certain proportion of patients become physical invalids if it continues long enough. Fear of heart disease and sudden death take the patient from doctor to doctor, from specialist to specialist until the patient gets referred to an understanding psychiatrist, with psychotherapy majority of patients get cured.

Personality disorders are not uncommon after heart ailments. In one of these personality disorders the patient seems to lose capacity for doing things for himself and requires help from others even in ordinary matters. He clings on to his relations like a helpless child. This ultimately become a nuisance to the other members of his family.

Others use the heart ailment as an emotional device for the domination of others. This type of aggressive behaviour is often a nuisance to patients’ relations. In contrast to above in compulsive type of personality disorder the patient meticulously follows all the precautions and medical advice to the letter. The observance of these rituals often intrudes into the lives of other members of his family that this becomes a source of distress. The heart patient with personality disorder thinks he has no psychiatric condition. It is the patient’s close relations who complain of the change in behaviour of the patient.

There is another category of heart patients who refuse to believe that they have heart disease. The neglect to observe the precautions and often neglect treatment. They become physically overactive. A patient few days after a heart attack may swim far out in the sea to show that he is not afraid of his heart ailment. These patients if not given correct treatment may get a relapse and often end in premature death. These patients are the chronically elated type or hypomanic type as opposed to depressed type.

In other cases, the cardiac neurosis is due the parents over-protection of the child who has been found to have a “heart murmur” by the family doctor. Over-protection of a child by the parents leads to mischief in later life as patients subconsciously use this idea of a “weak heart” to avoid unpleasant tasks and justifies his idleness.

We sometimes come across teenagers with cardiac neurosis who have not been sent to school because they have been found to have a heart murmur by the family doctor. When these children with heart murmurs are investigated we find that some of them have normal hearts.

It is known that anxious doctors and nurses have anxious patients. About two decades ago coronary thrombosis patients were given three months bed rest and a good number of them were cardiac invalids at the time of their discharge from hospital; as a result majority never returned to their previous jobs. Now it is known that prolonged bed-rest is harmful to “heart attack” patients.

With early mobilisation, less anxious attendants and better communication, nowadays we rarely see cardiac invalidism. Majority of coronary patients who are admitted to the cardiology unit leave hospital at the end of one week and majority resume their previous jobs in about twelve weeks.

Over the years doctors have been guilty of great sins in creating cardiac neurotics.

Till the days of Mackenzie who was a famous physician, many a boy was kept in bed for months on account of sinus arrythmia (normal variation in pulse with respiration), and on account of innocent heart murmurs. Today the brunt of cardiac neurosis fall on suffers of high blood pressure and coronary thrombosis.

Unless properly investigated by a cardiac physician any pain in the chest, palpitations and cardiac murmur etc., should be disregarded as unimportant and to lead a normal life. Otherwise as mentioned earlier the patient may suffer from cardiac neurosis and may become a nervous wreck for the lifetime. Such a patient is called a hypochondriac.