Cardiac neurosis (cardiac anxiety) - causes, therapy and symptoms

Cardiac neurosis (cardiac anxiety) - causes, therapy and symptoms

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Learn to overcome cardiac neurosis

The cardiac neurosis is also known as cardiophobia, cardiac phobia, Da Costa syndrome or Effort syndrome. It is one of the hypochondriacal disorders. The focus is on the fear of an undetected heart disease. There is usually no organic heart disease. Cardiac neurosis is often associated with panic-like anxiety attacks. Those affected are also referred to as cardiac hypochondriacs or cardiac neurotics. They are constantly worried about their heart function and, for example, check their pulse or blood pressure more than once a day. The fear of those affected can become so strong that panic attacks, fear of death and complete social withdrawal occur. Before a cardiac neurosis is diagnosed, cardiac neurotics often have a long path of suffering behind them.

Symptoms of cardiac anxiety

In contrast to the symptoms of a heart attack, those affected can in many cases precisely localize the pain in the heart. The symptoms associated with the cardiac neurosis include all vegetative, subjectively overrated side effects of fear. These include, for example:

  • Sweats that often spread all over the body,
  • Racing heart (tachycardia),
  • Stitches in the region of the heart,
  • Pain in the left arm,
  • a general feeling of tightness in the chest,
  • acute high blood pressure,
  • greatly increased pulse,
  • Nausea,
  • Dizziness,
  • Breathing difficulties such as shortness of breath to hyperventilation,
  • Sleep disorders,
  • In the presence of a doctor, the symptoms often go away quickly,
  • A cardiologist cannot determine any physical causes for the symptoms.

Duration of a seizure
A neurotic attack can last from fifteen minutes to two hours. The cardiac neurotics can feel the heartbeat and pulse exactly and concentrate massively on it. Due to the associated fear, they in turn influence the heart rate, which increases the symptoms: the famous vicious cycle begins. Those affected increase so much in the symptoms that such an attack can end in an emergency practice or in a hospital.

The fear of fear
Between the acute anxiety attacks, most cardiac neurotics are then afraid of fear (phobophobia). This restricts daily life so that those affected plan every step. They prefer to be near doctor's offices or hospitals, car trips are planned in this regard and nightly activities are largely stopped.

The thoughts revolve around the heart, the self-observation regarding heart-specific symptoms and the fear of being heart-sick, puts the body in constant alert and causes stress. Many sufferers worry so much about their physical well-being that they no longer believe they can do anything. They avoid any activity behind which they suspect potential dangers.

Constant conservation
Cardiac neurotics are constantly sparing and avoid physical stress, which could have a negative impact on their cardiac function. In doing so, they are increasingly putting themselves on the sidelines. They no longer go out with people and remain out of concern for their health, only within their own four walls. Small things such as a harmless cold or a loud bang can put those affected in fear and terror and trigger a new cycle of fear.


The cardiac neurosis is one of the somatoform, autonomous functional disorders. This means that the physical complaints caused by the disease are not physical, but psychological. The complaint picture increasingly affects the male sex and often occurs over the age of 40. Around 100,000 people in Germany suffer from this disease.

Traumatic events as a trigger
Triggers are usually real experiences of leaving, for example the death or illness of a close relative, separation from the beloved partner, but also cases of cardiac death or heart disease in a circle of friends or family environment.

The concerns and fears of such situations result in cardiac neurotics sometime in the first attack, after which those affected then concentrate more on their heart function. They fall into a protective posture that increasingly excludes them socially. This often creates further phobias, such as agora or claustrophobia (agoraphobia = fear of large spaces; claustrophobia = fear of tightness).

Previous illnesses as a trigger
Even people who have already suffered a heart attack due to excessive stress, the use of drugs such as heroin and cocaine or alcoholism and who had to be treated by emergency medicine can develop cardiac anxiety afterwards due to the traumatic experience.

Causes in childhood
According to specialist literature, a disturbed relationship between parents and their child is a risk factor for the development of cardiac anxiety later in life. Cardiac neurotics often describe their mothers as overprotective and dominant. Early separation of the parents or neglect of the child is also a possible reason for the development of the disease.

Conflicts and problems
Unsolved problems, difficult life situations, conflicts and stress influence the heart function. This reaction can be misinterpreted and perceived as a serious illness. This can be the cornerstone of a fear of the heart.

Course of the disease

People suffering from cardiac neuroses are afraid of cardiac arrest or cardiac death. That is why they constantly monitor their pulse and blood pressure. If your heart stumbles, you panic immediately. They keep asking themselves about their current state. Examples include sentences like:

  • "Is my heart beating properly?"
  • "Is my pulse too fast?"
  • "Didn't I just feel a sting in my chest?"

Out of this fear, activities are stopped or not started at all. Physical stress is avoided. Lonely areas are bypassed by car and important phone numbers of doctors and hospitals are constantly kept. Reports of heart disease are either consumed intensively or avoided entirely.

Those affected often feel that they are not being taken seriously
Cardiac neurotics often do not feel taken seriously. According to their own assessment, they are really sick and always go to internists, cardiologists or neurologists to finally get help. Most patients feel much better in the presence of the medical team because they feel safe there. If no organic disorders have been found, most patients are well for a while. But after just a few days or weeks, the question arises whether the doctor has not overlooked a heart defect or a heart disease. A new doctor's appointment will soon be arranged.

The social offside
A cardiac neurosis is primarily psychological. Accordingly, many sufferers also suffer psychologically. Patients with cardiac anxiety often try to avoid things and situations that could trigger fear. All places that associate them with fear are avoided. But going away, leaving the house becomes more and more difficult with time.

Families, friends and colleagues often don't know how to behave properly. Some turn away from the person concerned due to helplessness or helplessness. Many cardiac neurotics are lonely. Due to the lack of activity, the physical condition also deteriorates, which is why physical activities are increasingly perceived as strenuous. This again leads to the question of whether it is the symptoms of severe heart disease.

Cycle of fear
The cardiac neurosis puts the patient in a constant state of tension and alarm. This can lead to fear of fear, phobophobia. This is often not even known to those affected. Even small things like a loud noise can trigger an anxiety attack. The massive fear turns into panic. The symptoms are aggravated by panic. This can result in a panic attack, which in turn reinforces the fear of the heart.


People with existing heart anxiety need to be thoroughly examined to rule out possible heart disease. It must be taken into account that patients with an existing heart disease develop a cardiac neurosis just as cardiac neurotics can get a cardiac disease. The following examination methods are used:

  • Control of blood pressure and pulse,
  • Resting and exercise ECG (electrocardiogram),
  • Echocardiography (ultrasound of the heart),
  • extensive blood tests,
  • if necessary cardiac catheterization.

The influence of the psyche
Often a psychiatrist or psychologist has to be consulted to make the diagnosis. Studies have shown that 15 to 20 percent of the patients in cardiology practices are cardiac neurotics. Months or years can pass before the diagnosis of cardiac phobia is made. In the meantime, a number of sufferers have already completed invasive diagnostic procedures, such as the dangerous cardiac catheter examination. Many doctors often diagnose functional heart problems only to provide the patient with a diagnosis. However, sufferers experience their suffering as very real - including actual pain.

Most of the time, after extensive examinations and a discussion with the doctor, the patients feel reassured. However, after a while, doubts reappear, fear breaks out again and the vicious cycle begins again. Those affected will then request further examinations. This is why cardiac neurotics are particularly common in specialist practices. Unfortunately, repeated invasive examinations can in turn increase anxiety and should therefore be used very carefully.

Treatment of cardiac neurosis

At the beginning of therapy, the patient may be given psychotropic drugs to deal with the severe anxiety attacks. In principle, however, psychotherapy is usually required to eliminate the cardiac neurosis. This should strengthen self-confidence and change the way you look at yourself. Depending on the patient's situation, cognitive behavioral therapy or psychodynamic therapies such as psychoanalysis are usually used.

Cognitive behavior therapy
As part of cognitive behavioral therapy, cardiac neurotics learn how to deal with the disease and strategies on how to behave when seizures occur. The key element is exercise and physical exertion, such as jogging, walking or swimming, to show those affected that their heart is resilient, so that they regain more confidence in their body.

Psychodynamic therapies
Dealing with personal history plays a central role in psychodynamic procedures. The processing of traumatic events and experiences with caregivers should lead to more mental stability and self-confidence with this form of therapy, which should help to overcome fear.

Relaxation training
Targeted relaxation training to relieve stress, such as autogenic training or progressive muscle relaxation, is just as much a part of therapy as patience, since the cardiac neurosis is a long-term disease. In some severe cases, hospital admission is useful. Especially when outpatient behavioral or psychotherapy was unsuccessful. Overall, the chances of success are good if the patients can engage in the therapy.

Naturopathy for cardiac phobia

A cardiac neurosis is a disease that needs to be treated by experienced medical professionals. Accompanying naturopathic treatment can additionally support the therapy. The nervous overexcitability associated with the disease and the unstable mood can be positively influenced by suitable naturopathic forms of treatment. Above all, derivation and discharge procedures belong here in the treatment spectrum of naturopathic practices.

Cupping massages
Cupping massages with suitable essential oils have a relaxing, circulation-enhancing and generally energizing effect. The prerequisite is that the cardiac neurosis has no organic cause.

Tension and muscle hardening
The patients are constantly on alert, which of course can lead to massive tension and myogelosis (palpable, painful muscle hardening). In order to solve the hardening of the muscles, the so-called Baunscheidtieren is often used in naturopathy. The skin is gently scratched and then a so-called Baunscheidt animal oil is applied, which should stimulate the blood circulation and the lymph flow.


A detailed medical history, which should generally be the basis of all naturopathic treatment, is particularly important for constitutional treatment with homeopathy. Here the appropriate remedy for the patient is determined individually. Examples include:

  • Coffea,
  • Cimicifuga,
  • Gelsemium,
  • Ignatia,
  • Nux vomica.

Racing heart, palpitations and restlessness
Complex agents are also used for palpitations, palpitations, constriction of the heart and states of restlessness. These contain substances such as:

  • Crataegus (hawthorn), an active ingredient used for palpitations and restlessness,
  • Cactus (queen of the night), which helps with cramping heart pain or constriction of the heart,
  • Gelsemium (yellow jasmine), which is used primarily for palpitations or the feeling that the heart would stop,
  • Ignatia (Ignatius Bean), the remedy for heartache,
  • Sedative (calming) plants like valerian, St. John's wort, lemon balm, passion flower and hops.

Nausea and gastrointestinal disorders
For example, remedies help with accompanying complaints such as nausea and vomiting and other gastrointestinal disorders:

  • Caraway seed,
  • Fennel,
  • Coriander,
  • Ginger,
  • Peppermint.

Fight the fears
Anxious patients suffer from cardiac neurosis. In order to do something about the constant fears, various Bach flower mixtures of Bach flower therapy are suitable. These can serve well alongside psychotherapy. The Bach fear flowers are Aspen, Mimulus and Rock Rose. In order to stabilize the entire vegetative environment of those affected, daily alternating showers, dry brushing and Kneipp foot baths from hydrotherapy at home complete the treatment. (sw, vb)

Author and source information

This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Susanne Waschke, Barbara Schindewolf-Lensch


  • German Society for Psychosomatic Medicine and Medical Psychotherapy e.V. (DGPM) and German College for Psychosomatic Medicine (DKPM): S3 Guideline Functional Body Problems, as of July 2018, awmf.org
  • Dr. Julia Ukena: Resynchronization Therapy vs. ICD implantation: Influence on cardiac anxiety, depression and quality of life, German Society for Cardiology - Cardiovascular Research e.V., March 2016, dgk.org
  • Walter de Gruyter GmbH: Cardiac neurosis (accessed: July 29, 2019), pschyrembel.de
  • German Heart Foundation: When the psyche hits the heart (accessed: July 29, 2019), herzstiftung.de
  • Amboss GmbH: Somatoform disorders (F45) (access: July 29, 2019), amboss.com
  • Sauer, Nina / Eich, Wolfgang: Somatoform disorders and functional disorders, Deutsches Ă„rzteblatt CME Kompakt, 2009, aerzteblatt.de
  • Harvard Health Publishing: Treating somatoform disorders (accessed: July 29, 2019), ealth.harvard.edu

ICD codes for this disease: F45ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.

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