PSYCHOPHYSIOLOGICAL APPROACH TO MANAGEMENT OF PATIENTS WITH CONGESTIVE HEART FAILURE

To facilitate an appreciation of the psychosomatic implications of congestive heart failure, the emotional problems of 30 patients being treated for cardiac decompensation were defined. Emotional difficulties of a chronic nature were found to be an integral part of daily living in 26. Cardiac decompensation because the patient fails to take digitalis which failure, in turn, is the result of his emotional problem is an example of indirect relationship between the mental and organic maladies. This was present in 14 patients. In 19 an acute emotional stress such as the death of a beloved relative had a more direct influence, through as yet only partially understood neurohumoral mechanisms, in prolonging or precipitating an episode of congestive failure. The practical implication of these psychosomatic relationships is indicated by the known facts that heart function, venous pressure, and arterial pressure are all affected by emotional stress or by hormones released at the time of stress.