Projection site heart: When psychological conflicts influence the body

As early as ancient Egypt, there was a disease of the heart, the cause of which was called the fear of the mind. The interplay between the psyche and the heart has therefore been known for a long time – but for a long time it was not given much importance. Meanwhile, things are different because patients with heart disease often suffer from psychological comorbidities. And these, in turn, influence the course of cardiac problems.

Psychocardiology is a comparatively young discipline that deals with the interaction of cardiac diseases and psychological changes. This is because depression, anxiety, and post-traumatic stress disorder (PTSD) in particular can increase hospitalization, morbidity, and mortality rates in patients with heart disease. Psychosocial stress and chronic stress can also increase the risks. Mental health is closely related to the functionality of the heart. They can occur at different times in the course of the disease and contribute to the development of the disease as an independent risk factor, negatively influence the course as a comorbid disease, or be triggered by the cardiac disease.

For coronary heart disease (CHD), for example, it has been found to be more likely to occur in individuals with low socioeconomic status and chronic workplace stress. Depressive symptoms such as feelings of low spirits, hopelessness and listlessness occur in 20-50% of CHD patients. In 15-20%, these are pronounced clinical symptoms of depression. This mainly affects women under the age of 60 after a heart attack. Vice versa, depressive symptoms increase the risk of CHD and have a negative influence on the course of the disease. This is explained on the one hand by pathophysiological changes such as dysfunctions of the endocrine system and a chronically increased activity of the sympathetic nervous system, which can lead to a progression of atherosclerosis. On the other hand, depression is closely associated with inflammatory processes that result in increased levels of interleukin-6 and C-reactive protein and increased platelet activity.

Heart out of time

A similar situation can occur with cardiac arrhythmias. Here, too, there is a bidirectional relationship between psychological and physical symptoms. Mental disorders such as anxiety and panic disorder can trigger cardiac arrhythmias as well as be caused by them. Common arrhythmias associated with mental disorders include extrasystoles, supraventricular tachycardia (SVT), atrial fibrillation, and ventricular arrhythmias. In panic disorders, a real vicious circle of anxiety can develop. During an attack, physical changes are perceived, which in turn lead to intense anxiety (Fig. 1) .

Differential diagnoses in heart failure

The proportion of heart failure patients with comorbid depression is extremely high at 21.5%. Moreover, it increases with increasing severity. In addition to significantly impairing quality of life, depressive symptoms lead to increased hospitalization rates and double the risk for subsequent clinical events and mortality. However, affect is often overlooked as patients withdraw and show their emotions less obviously. Another indication may be cognitive impairment, the risk of which is generally increased in patients with heart failure and seems to be further exacerbated by depression. Symptoms manifest as memory deficits, executive dysfunction, and slowed processing speed. Therefore, if a patient experiences problems with comprehension or adherence, cognitive dysfunction should be investigated as a differential diagnosis.