Psychosomatic Medicine 8:293-319 (1946)
© 1946 American Psychosomatic Society

Studies on the Nature of Certain Symptoms Associated with Cardiovascular Disorders

¹ Departments of Medicine (Neurology) and Psychiatry, Cornell University Medical College and The New York Hospital
² Departments of Medicine (Neurology) and Psychiatry, Cornell University Medical College, and The New York Hospital

Day-to-day studies were made over a period of almost a year of the symptoms and cardiovascular and respiratory functions of healthy human subjects, and short term observations were made on selected patients.

Emphasis was placed upon the reactions to persistent low-grade stresses and strains which are a part of "every day" living and which constitute the core of the bedside problem rather than upon the well-known responses to major life crises. These studies have revealed the following:

Dyspnea associated with inefficient pulmonary ventilation may occur in response to stress-producing life situations in association with anxiety, anger, guilt, rage, frustration, and tension.

Palpitation associated with increased stroke volume may occur under similar circumstances.

Heart pain in the presence of anatomical narrowing of the coronary arteries may result from increased work of the heart attendant upon prolonged elevation of the blood pressure and cardiac output in association with rage, resentment, anxiety, fear, and tension.

Heart pain in the presence of anatomical narrowing of the arteries may result from a fall in the cardiac output and coronary blood flow in association with desperation and defeat.

Giddiness and faintness may result from cerebral anoxia attendant upon diminished venous return to the heart. Also, giddiness and faintness may result from hyperventilation, which is followed by cerebral vasoconstriction, impaired dissociation of oxyhemoglobin and cerebral anoxia. Both types of cerebral anoxia occur in response to stress-producing life situations in association with feelings of exhaustion, anxiety, fear, and during the early part of convalescence.

Fatigue as experienced by patients is a complex state dependent upon emotional attitude, the absence of a dominant motivation and the presence of a stress-producing life situation with accompanying inefficiency of cadiovascular and respiratory function.

Individuals differ as regards the intensity and duration of the cardiovascular and respiratory responses to life situations. The fact that a single subject tends to react under different circumstances in many different ways suggests that the individual is manifesting a variety of ways of dealing with his environment as regards his cardiovascular and respiratory functions.

These results indicate that, in a setting of adverse life circumstances and associated emotional reactions, performance in terms of respiration and work of the heart is costly. This high cost may manifest itself in cardiovascular symptoms which are not dependent alone upon gross structural heart disorder. This uneconomical performance may also manifest itself in impaired total efficiency of the individual.

Note:
The work described in this paper was done under a contract, recommended by the Committee on Medical Research between the Office of Scientific Research and Development and Cornell University.

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