Cardiac neurosis

Japanese: 心臓神経症 - しんぞうしんけいしょう（英語表記）Cardiac neurosis

What is the disease?

Chest pain, Palpitations ( Excitement ) Cardiac neurosis is a condition in which a patient shows symptoms common to heart disease, such as shortness of breath, difficulty breathing, and dizziness, but no abnormalities are found in a heart examination. It would be more accurate to call this a "mental illness" rather than a heart disease.

This is a disease that is common among nervous people, women who have become concerned about their physical condition because they have more free time now that they are no longer caring for their children, and people who have lost a loved one to heart disease and are anxious about heart disease.

What is the cause?

Possible causes of cardiac neurosis include stress, overwork, and extreme anxiety about heart disease. Stress, overwork, and anxiety stimulate the sympathetic nervous system, which activates the heart. This causes the heart rate to increase and palpitations to become stronger. Once you experience these symptoms, you may start to worry that you have heart disease, and as that anxiety grows, you may start to experience more severe symptoms such as chest pain, difficulty breathing, and dizziness.

How symptoms manifest

Symptoms include chest pain, palpitations, shortness of breath, difficulty breathing, and dizziness. Of these, most patients complain of chest pain, but at first glance, the pain may seem Angina ( Public Notice ) The symptoms are similar to those of , but on closer inspection there are many differences.

The chest pain felt by cardiac neurosis is described as "throbbing" or "stinging", the area of pain is limited to a very small area on the left side of the chest, and the pain gets worse when you press on it with your hand. This pain does not occur when you are exercising or excited, but usually appears when you are alone and quiet, and can last for a long time, even all day.

Testing and diagnosis

First, we perform general heart disease tests to determine whether or not there is a heart disease. We then check for the presence of diseases that may cause chest pain, such as pleural disease and esophageal spasm, and only after these are ruled out is cardiac neurosis diagnosed. For patients who complain of severe chest pain attacks and it is difficult to distinguish from angina, we may prescribe sublingual nitroglycerin tablets to be taken when a chest pain attack occurs, and the effectiveness of the drug at that time may be observed to make a diagnosis.

Treatment methods

Because the cause of cardiac neurosis is a "heart" problem, we explain in detail how the symptoms occur so that the patient understands, while also investigating what is causing the patient's symptoms and providing advice on how to address it.

If symptoms are severe, suppress the heart's activity β ( beta ) Blockers and tranquilizers may also be prescribed.

If symptoms persist despite these treatments, you may need to see a psychosomatic or neuropsychiatric doctor.

Yasuhiro Maeshima

Source: Houken “Sixth Edition Family Medicine Encyclopedia” Information about the Sixth Edition Family Medicine Encyclopedia

Japanese:

どんな病気か

　胸痛、動悸(どうき)、息切れ、呼吸困難、めまいなど、心臓病によくみられる症状を示しているにもかかわらず、心臓を検査しても何も異常が見つからないものを、心臓神経症といいます。これは心臓病というよりはむしろ「こころの病気」というほうが正しいといえます。

　神経質な人や、子どもから手が離れ、暇な時間ができたために自分の体の状態が気になるようになった女性、親しい人を心臓病で亡くして心臓病に対して不安感を抱いている人などによくみられる病気です。

原因は何か

　心臓神経症の原因としては、ストレス、過労、心臓病に対する極度の不安などが考えられます。ストレス、過労、不安感などは心臓のはたらきを活発にする交感神経を刺激します。すると、心拍数が増え、動悸を強く感じたりします。一度こうした症状を感じると、「自分は心臓病ではないか？」という不安が生まれ、その不安が徐々に大きくなるにつれて、胸痛、呼吸困難、めまいなどのより大きな症状を感じるようになってしまうのです。

症状の現れ方

　胸痛、動悸、息切れ、呼吸困難、めまいなどの症状を示します。このうち胸痛はほとんどの患者さんが訴えるものですが、その痛みは一見、狭心症(きょうしんしょう)の症状と似ています。しかし、よく調べると多くの点で違いがあることがわかります。

　心臓神経症で感じる胸痛は「ズキズキ」とか「チクチク」と表現されるような痛みで、痛む部分が左胸のごく狭い範囲に限られており、手で圧迫すると痛みが強くなるという点が特徴です。この痛みは運動したり、興奮したりしている時ではなく、たいていは一人で静かにしている時に現れ、長い時は1日中続くこともあります。

検査と診断

　まず一般的な心臓病の検査を行い、心臓の病気の有無を判断します。さらに胸膜の病気や食道けいれんなど胸痛の原因となる病気の有無について調べ、それらが除外されて初めて心臓神経症と診断されます。胸痛発作を強く訴える患者さんで、狭心症との区別が難しい場合にはニトログリセリン舌下錠を処方して、胸痛発作が起きた時に服用してもらい、その時の薬の効き具合をみることで診断する場合もあります。