Cardioneurosis is defined as a separate category of psychosomatic disorder organ neuroses. At the same time provides for the possibility of participation in the formation of functional disorders of the cardiovascular system of somatic (mainly cardiovascular) disease. Therefore, the diagnosis of a qualified cardioneurosis requires expert assessment of the patient as a psychiatrist and cardiologist.
Diagnostic criteria cardioneurosis:
Continuous or recurrent for more than three months of symptoms:
discomfort or pain in the heart
change in the "strength" and heart rate ("tachycardia", tachycardia, extrasystoles).
The emergence or worsening of symptoms in connection with stressful situations or during periods of hormonal changes
Signs of autonomic dysfunction
marbling or cold extremities
resistant white dermographism
lability of heart rate with a tendency to tachycardia
lability of blood pressure.
Lability and nonspecific changes in the final part of the ventricular complex, positive ECG test with potassium chloride, β-blockers, hyperventilation and orthostasis, a temporary reversal of the T wave during exercise test.
Clinical characteristics cardioneurosis
Symptom cardioneurosis presented abnormal sensations (gravity, pressure), or pain in the heart (cardialgia) in combination with the strong sense of palpitations, heart rate lability (a tendency to tachycardia, arrhythmia) and blood pressure (often with a tendency to improve the transient), as well as the attendant signs of autonomic dysfunction (the local sweating, cold extremities, or marbling, firm white dermographism).
In a series of mental disorders in patients with cardioneurosis dominated (65.2%), anxiety symptoms, which is formed in the anxiety disorders or anxiety depression. Among the anxiety disorders in patients with clinically cardioneurosis found mainly completed form of panic attacks, with a predominance of spontaneous (ie not related to external factors), anxiety attacks.
Emerging in the functional disorders of panic attacks include changes in rhythm and force of heart rate (tachycardia, extrasystoles, tachycardia), blood pressure fluctuations with a tendency to transient hypertension at an altitude of anxiety attack, polymorphic cardialgia. Often there irradiation of pain in his left shoulder and back area. Exacerbation of symptoms cardioneurosis during a panic attack may be accompanied by feelings of dizziness, a feeling of weakness or muscle tension.
Approximately 17% of patients with depressive disorders cardioneurosis revealed that qualify as endogenous depression, mostly mild or moderate in severity within cyclothymia and, rarely, as in the phase of affective personality disorder, and dysthymic disorder. In patients with cardioneurosis suffering from cyclothymia, revealed spontaneously manifesting anxiety-hypochondriacal (somatisation) depression: a relatively mild conditions gipotimii (depressed, depressed mood, decreased activity) overlap pronounced anxiety disorders and functional disorders of the cardiovascular system.
In some cases, revealed depression, acting as a manifestation of the dynamics of personality disorders (borderline type). The structure is dominated by depressive symptom asthenic disorders are closely associated with functional disorders of the cardiovascular system and false angina, as well as the phenomenon of anergy, apathy, anhedonia, dysphoria (signs of negative affectivity).
Dysthymic disorder (neurotic depression lengthy) take place in an "somatisation dysthymia." In the clinical symptoms of dysthymia cardioneurosis persist and come to the foreground on the background of depressive affect.
Cardialgia, cardiac arrhythmias, pressure oscillations are combined with the asthenic manifestations. Actually gipotimii (depressed mood) shows slowing and difficulty of all mental acts, reduction drives, sleep disturbance and appetite. The prevailing indifference, inability to experience joy, concern, compassion. At the same time recorded symptoms depressed mood (low self-esteem, pessimism, incompetence) subjectively assessed by patients as a consequence of a permanent physical ailments.