Mao Jialiang, Department of Cardiology, Renji Hospital, Shanghai Jiaotong University School of Medicine
A 28-year-old male patient developed chest tightness, palpitations, and left chest tingling in July 2005 due to cold, followed by recurrent chest tightness and palpitations. He was treated with rest and various drugs such as heart stabilizing pellets, coenzyme Q10, geranium, ATP, and cantharone, but the patient’s symptoms were recurrent and tended to worsen. Since the patient’s condition was never fully controlled, and some doctors told him that the course of chronic viral myocarditis is sometimes very long and difficult to cure, when he further asked the doctor what would happen if his disease did not develop properly, the doctor told him that it might turn into heart failure, which made him feel very scared and fearful. He would often think about his disease afterwards, and any discomfort in his body would cause him to be nervous and worried, fearing that his condition would worsen, and he would often lose sleep at night, when his chest tightness and panic would be even worse, and sometimes he even feared that he would die in his sleep, which made him even more afraid to sleep and to be alone. Many times, he would inexplicably feel panic attacks and rapid heartbeat, and the attacks became more and more frequent, once a week or a few days at the beginning, but finally he would have this feeling every day. He was in the hospital emergency room for 36 hours, but his symptoms still could not be relieved, so he was in pain and his mind kept thinking: “I’m dying, I’m dying”. The doctor thought he had “severe viral myocarditis and cardiac insufficiency”. He felt a bit desperate and asked his family to come to the hospital, saying he would make a will to say goodbye to his family. Mao Jialiang, Department of Cardiology, Shanghai Renji Hospital
When I saw him, he was lying on the bed looking very weak, his whole body was still sweating non-stop, and his heart was beating quickly 120 times/minute, but the patient was able to lie flat nor did he have the swelling that occurs in severe cardiac insufficiency. Checking the examination after admission, the patient was positive for coxsackie virus only, while repeated chest X-ray and cardiac ultrasound did not reveal any cardiac abnormalities, the cardiac enzyme profile was normal and there were no signs of myocardial damage, and the 24-hour ECG had more than 4000 premature ventricular beats, while the ECG only showed sinus tachycardia and no other abnormal manifestations. The diagnosis of “severe viral myocarditis and cardiac insufficiency” lacked sufficient evidence. His symptoms did not match his test results. He was given a psychological scale score, which showed a significant state of anxiety and depression, and it was possible that his illness was cardiac neurosis – a specific form of psychological disorder anxiety disorder. By further questioning the patient, we learned that the patient’s father died early and now lives with his mother, the family’s condition is not too good, he talked about a girlfriend and likes her very much, but her condition is better than his, he feels very stressful and always worried about losing her, plus his work is not going well, which often makes him upset.
We first comforted him by telling him that his disease was not as serious as he thought and that severe viral myocarditis and cardiac insufficiency were not established, so that he could release his mind and relax his tension. As the patient did not sleep well for ten days, we gave him sufficient sedative sleep and adjusted the direction of treatment, focusing on anti-anxiety and depression medication, which relieved the patient’s symptoms after two weeks and fully controlled them after one month. Now the patient has stopped taking any medication and has completely resumed normal life and work.
Due to the stressful work in modern society, psychological disorders are becoming the main diseases affecting human health in the twenty-first century, and people are facing a new round of disease challenges, which come fiercely but silently, and we are not fully prepared to meet this challenge, and more often than not, in clinical practice, we tend to unconsciously refuse to discuss the impact of psychological disorders on our body. Contrary to previous conventional wisdom, statistics show that only 30% of patients with psychological disorders are seen in counseling specialties, while up to 70% of patients with psychological disorders are seen in general hospitals. This is because psychological disorders do not only cause emotional problems, but also cause a variety of physical discomfort, which makes these patients or some doctors more inclined to look for the cause in the physical aspect, especially when it is a little abnormal with some laboratory tests are more likely to be confused, coupled with the fact that there is no effective laboratory tests for psychological disorders like other diseases, which makes psychological disorders often This is a problem that deserves the attention of both doctors and patients in the future.
Mao Jialiang, Department of Cardiology, Renji Hospital, Shanghai Jiaotong University School of Medicine 2009-3-12