Dr. Ralf Berthel, a specialist in internal medicine and senior physician at Martin Luther Hospital in Berlin was an expert for an article about heart anxiety neurosis in the B-to-C-magazine of German pharmacies 'Apotheken-Umschau'.

Heart stings, palpitations, shortness of breath – patients with cardiac neurosis believe they feel symptoms of a heart attack but are physically completely healthy. Where do the complaints come from?

Heart (anxiety) neurosis is also called Kardiophobie or Da Costa's syndrome. It is one of the anxiety disorders. The ones who are affected believe to suffer from a heart disease or a heart attack. The heart of the patient is healthy but the fear of getting a heart disease causes the problems.

Experts estimate that up to five percent of the population suffer from these so-called functional cardiovascular disorder. "Mostly younger patients, males between 18 and 40 years, suffer from it", explains Dr. Ralf Berthel, a specialist in internal medicine and senior physician at Martin Luther Hospital in Berlin. A famous patient was the poet Berthold Brecht, who apparently suffered from heart neurosis already as a young man.

Symptoms: The Heart Attack Which is None

Some patients with heart anxiety neurosis feel discomfort over a long period that resembles a heart disease. They experience the symptoms as very threatening, frightening and very real – the more, the more they turn their attentions to it. This may be tachycardia and palpitations, but also heart pain that often radiates to the left arm. Other symptoms include a stinging or burning sensation in the heart area as well as pressure and tightness in the chest.

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Important to know is that such symptoms actually can indicate a heart disease – such as a heart attack. Therefore, they should be investigated immediately by a physician if they occur for the first time! However, in patients with heart anxiety a thorough investigation reveals that the heart is completely healthy. Nevertheless, the complaints keep coming back.

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The fears about their own heart health lead in many sufferers into fits and can lead to a panic attack with shortness of breath and hyperventilation, profuse sweating, dizziness and feelings of powerlessness. Some patients according to Berthel also experience veritable "heart attacks" with fear of dying.

Symptom-free periods are usually determined by the concern and fear of the next "attack". Sufferers often deal extensively with the subject of heart disease, they repeatedly check their pulse and blood pressure and only feel safe in the vicinity of hospitals and doctors.

From one Doctor to Another

Does the doctor find no physical cause after such an "attack", the patients often do not feel any better or only for a short period. It is difficult to consider the possibility that the physically noticeable symptoms could be psychosomatic. The symptoms clearly seem to come from the heart. Often enough this is the beginning of a year-long "Doctors Odyssey".

Fear of Fear

Afraid of aggravating the alleged heart problems, many of those affected try to protect and restrict themselves in their daily activities. Possible consequence: Supposedly serious heart symptoms sometimes occur more frequently. Because the overall fitness has declined.

People with heart anxiety suffer from the fear of fear. They constantly observe themselves and worry about their heart – which gets them into a permanent state of alarm. Usually they are not even aware of this.

Cause: The Psyche

For heart anxiety there usually are no physical causes. The symptoms usually arise by mostly unconscious fears. Internal conflicts are transferred to a different destination, in this case to the heart.

Berthel states that heart anxiety can be triggered by stressful life events such as separation, occupational problems, accidents, illness and the death of a close person. Many sufferers know a person, who actually had a heart disease, like a serious heart attack.

"Sufferes interpret a single heart tripping or a pulse which is a little bit faster than normal as a sign of a life threatening heart disease", the expert of Internal Medicine explains. By this fear increases which activates the nervous system: the pulse becomes even faster (tachycardia), the patient is breathing faster (hyperventilation) and experiences dizziness. "If the anxiety increase further it can can lead to a panic attack", Berthel says.

For psychologists heart anxiety neurosis is a kind of defense mechanism: The supposed heart disease distracts from real fears which temporarily loose their threat for those affected.

Sometimes misunderstandings with physicians can trigger a cardiac neurosis, for example, if the harmlessness of some findings are not properly explained to the patient or findings get more weight than is appropriate.

A cardiac neurosis may also occur in conjunction with other mental illnesses such as depression or anxiety disorders.

Treatment of Cardiac Anxiety

If symptoms appear for the first time, the patient must be investigated thoroughly. The doctor will probably carry out an EKG, a stress test or an echocardiogram and maybe do some blood work as well. Can he find no physical cause and the symptoms do continue the patient should start psychotherapy as soon as possible.

"It is important that the patient gets comprehensive information about the nature and prognosis of his troubles", advises Berthel. The aim of psychotherapy is to cautiously make the patient aware that there is no organic cause of his heart problems. At the beginning of the therapy exercises in breathing and relaxation can help to cope with the symptoms as can progressive muscle relaxation or autogenic training.

In cognitive behavioral therapy the patient learns to deal with his heart anxiety attacks. Using a psychodynamic process the therapist helps the patient to recognize the role his personal experiences played in the development of the disease.

In severe forms of heart anxiety sedatives or antidepressants may be prescribed temporarily. This is a possibility especially when at the same time the patient suffers from depression or an anxiety disorder. "However, the drugs should not be used uncritically", says Berthel. Under no circumstances they should replace psychotherapy.

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