Cardiac Neurosis – What It Is and Its Symptoms

Neurotic disorders, categorized within the broad spectrum of anxiety-related conditions, represent a class of psychological abnormalities characterized by excessive, often irrational experiences of anxiety, uncertainty, or panic-like fear. Their etiology is multifaceted and complex, potentially arising from chronic exposure to stressors such as sustained psychological strain, societal pressures, or adverse occupational environments. Biological factors also play a critical role, particularly disruptions in neurotransmission—where impairments in the synthesis, release, or metabolism of neurotransmitters (e.g., serotonin, dopamine, GABA) compromise normal neuronal signaling. Environmental influences, including the misuse of psychoactive substances (such as alcohol), further contribute by altering the structural and functional integrity of the nervous system. In most instances, these disorders emerge from the cumulative interaction of multiple determinants, rendering their diagnosis and treatment a process that demands a comprehensive, integrative approach.

Da Costa’s syndrome, alternatively referred to as cardiac neurosis, soldier’s heart, neurovegetative dystonia, or nervocirculatory asthenia, constitutes a cluster of psychosomatic complaints primarily affecting the cardiac muscle under conditions of chronic or severe stress. The condition was first documented by the American cardiologist Jacob Mendes Da Costa, who identified its prevalence among soldiers engaged in the U.S. Civil War. Hallmark features of this disorder include symptoms mimicking cardiovascular pathology, yet without detectable organic alterations in heart structure, thereby underscoring the predominant influence of psychological and neurovegetative factors in its development.

The symptoms associated with cardiac neurosis can be categorized into two primary groups: psychological disturbances and somatic manifestations. The first category encompasses disorders characteristic of neurotic states and other mental health conditions. These include, but are not limited to: difficulties in sustaining attention and focus, heightened irritability with a propensity for anger outbursts, chronic sleep disturbances—particularly with falling and staying asleep—depressed mood with depressive tendencies, feelings of alienation and social detachment, diminished capacity for experiencing joy and fulfillment in daily activities, and an exaggerated sense of anxiety and apprehension. The second group of symptoms pertains directly to dysfunctions of the cardiac muscle, which is the basis for the term "cardiac neurosis." Patients predominantly experience intense retrosternal pain, often described as a sensation of pressure or stabbing. Additionally, individuals with this condition frequently exhibit: elevated blood pressure, palpitations, episodes of dizziness, shortness of breath, and excessive sweating. A critical distinction from cardiological diseases is that these symptoms predominantly manifest at rest, whereas in most heart conditions, functional impairments become apparent during physical exertion. Other potential somatic symptoms include: tremors in the hands, digestive dysfunctions, persistent fatigue, paresthesias (uncomfortable tingling sensations in the skin, e.g., in the facial area), and gastrointestinal complaints such as diarrhea or heartburn.

Accurate clinical diagnostics is the foundational step in managing cardiac neurosis. An electrocardiogram (ECG) is indispensable to definitively rule out underlying organic cardiovascular disorders, such as arrhythmias or ischemic heart disease. Laboratory blood testing is equally vital, as it identifies potential micronutrient and electrolyte deficiencies; subnormal levels of magnesium, potassium, or calcium directly influence neuromuscular excitability and blood pressure regulation. Evaluating thyroid function via TSH and free thyroid hormones is also standard protocol. When diagnostic tests demonstrate no organic abnormalities, cardiac distress is predominantly attributable to psychological factors, warranting consultation with a mental health professional. The core pillar of treating cardiac neurosis is cognitive-behavioral psychotherapy, which aids patients in identifying anxiety triggers, diffusing emotional hyperarousal, and acquiring effective coping mechanisms. Psychotherapy is frequently complemented by pharmacotherapy, wherein psychiatrists may prescribe anxiolytics or modern antidepressants (such as SSRIs). For prominent sinus tachycardia and palpitations, cardioselective beta-blockers targeting β1 and β2 adrenergic receptors are commonly utilized to stabilize heart rate and alleviate sympathetic strain. All of these medications require strict medical prescription. Lifestyle modifications represent an integral component of recovery: – Maintaining a balanced, whole-food diet rich in electrolytes; – Restricting alcohol and excess caffeine intake; – Enforcing consistent sleep hygiene and restorative rest; – Establishing healthy boundaries between occupational duties and personal life; – Reducing recreational screen time and digital overstimulation; – Engaging in regular, low-impact exercise such as swimming, walking, or yoga. In milder cases, phytotherapy may offer valuable symptom relief through calming botanicals such as valerian (*Valeriana officinalis*), hop strobiles, lemon balm, lavender, and hawthorn (*Crataegus*). Crucially, patients must never self-administer herbal remedies concurrently with prescription cardiac or psychiatric drugs without direct medical oversight to avoid harmful drug interactions.