Misinterpretation of symptoms, physical findings, and electrocardiograms can lead to iatrogenic heart disease (cardiac neurosis) in patients without actual cardiac pathology.
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Clinicians must avoid mislabeling anxiety symptoms as cardiac disease to prevent iatrogenic neurosis; case reports leave open the need for refined diagnostic criteria.
There are divergent opinions about the etiology of iatrogenic heart disease and certain common precipitating causes which need to be stressed to physicians at this period of high public awareness and fears of heart disease. The manifestations of the syndrome (cardiac neurosis) are a deep-seated fear of heart disease, associated with symptoms of fatigue, breathlessness, palpitation, chest pains, exhaustion, apprehension, tremulousness, and often signs of vasometer instability. Fifty cases of anxiety psychoneurosis, including 13 cases of severe cardiac neurosis (iatrogenic heart disease), were found in this study. None of the patients had heart disease, but all had been told they had, on the basis of misleading history, physical examination, or electrocardiographic evidence. The physician's interpretations included those of symptoms, physical findings, and electrocardiograms, inevitably leading to wrong or vague advice.
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John W. Keyes (1965) studied this question.
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