Psychocardiology – diagnostic problems in cardiology

Psychocardiology is a field of psychosomatic. Psychosomatic is a discipline which investigates the influence of psychological factors and environment on human health and physiology. It is a interdisciplinary branch which connects scientist knowledge from psychiatry and general medicine. One of its subcategory is psychocardiology. It is especially important since cardiovascular diseases are the most common civilization-related diseases and number one cause of death worldwide (WHO 2008).(1) Among the important risk factors of the cardio-vascular diseases are psychosocial aspects.

Psychocardiology is dealing with a role of the factors other than somatic in etiology, course of the disease and the treatment. Especially often comes to psychosomatic stroke-like attacks and such a patient can be a problem for many doctors. The symptoms can be unequivocal for heart attack but laboratory findings don’t confirm that diagnosis (troponin, ECG twice in a period of 6-8 h). When the patient doesn’t respond to the standard treatment course it is the time that a doctor has to decide to include drugs more characteristic for psychiatric therapy which slightly influence the circulatory system but they contribute significantly to the improvement of the patient’s condition. It may be said that the treatment of the patient with psychosomatic disease is more difficult because it demands more engagement from the doctor as well as from the patient and it is more than administering drugs and monitoring the patient’s state.(2)Such people need a special psychological support, they have to be patient and very engaged in the therapy which is more like a psychological-psychiatric treatment than cardiologic therapy.

Unfortunately, there are problems like where the patients with psychosomatic cardiovascular diseases should be treated. A cooperation between cardiologists (who have contact with the patients in emergency cases, should diagnose them properly and assign the patients to special group), psychologists, psychiatrists and psychosomatic specialists (if such specialists are in the country) is needed. The opinion about the patient should be holistic, focus precisely on a given patient, the course of the disease and possibilities of treatment.(3)

The European guidelines help to detect psychosocial risk factors by asking the patient a few questions about social position, education level, social relationships, stress at home and at work, depression and enmity. Especially bad – promising are low socioeconomic position which contributes to unhealthy lifestyle, depression, poor social support and stress at work. This factors are connected with increased activity of the sympathetic-adrenal system (increased heart action and reactivity of blood pressure, increased blood viscosity), activation of pituitary-adrenal system (disturbance of daily cortisol and serotonin secretion), disturbance in concentration of fibrinogen, CRP, PAI-1, predisposition for abdominal obesity and its complications.

As we can see, psychosocial risk factors may lead to activation of mechanisms responsible for somatic dysfunction of cardiovascular system. That is why it is hard to assign patients only into psychosomatic disorders group. Even if many risk factors were diagnosed and if there were psychosomatic coronary pain episodes, it is necessary to eliminate a heart attack. Proper psychological support is also important in typical somatic cardiovascular problems (state after cardiac surgeries and procedures or heart infarcts). It leads to improvement of the patients’ psychological condition, prevents recurrence of the disease and improves chances of the treatment success. That is why it is important to pay attention to psychocardiologic aspects and take care of the patient holistically. It is easier if there are appropriate specialists.

Written by: Magdalena Chorążka

2. Sobczak M., Kasprzak J., Drygas W. Psychokardiologia – wprowadzenie do nowej dziedziny naukowej. Kardiologia Polska 2011; 69,8: 838-843
3. Christoph Herrmann-Lingen et All. Interdisziplinäre Kursfortbildung Psychokardiologische Grundversorgung. Psychother Psych Med 2011; 61(11): 489-490

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