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.

If too low levels of calcium, magnesium or potassium are essential to determine whether symptoms and malfunction of the heart muscle are not the result of serious diseases (e.g. arrhythmias), a laboratory blood sample analysis plays an equally important role. On this basis, it is possible to assess the presence of deficiencies in certain vitamins and minerals. If the ECG test is necessary to determine if symptoms and impairments of heart muscle pressure or impaired neurotransmission are important, however, a number of factors may also play a role in reducing the activity of the blood vessel hormone response.