The syndrome, referred to in 1864 by Hartshorne1 as "cardiac muscular exhaustion" and in 1871 by Da Costa2 as "irritable heart syndrome," has undergone so many name changes that it is almost possible to "date" a physician by the name he selects. To an old-timer it may still be "Da Costa syndrome"; to a later graduate it may be "cardiac neurosis," "disordered action of the heart," "soldier's heart," "effort syndrome," or "neurocirculatory asthenia"; to a new arrival it can be Holmgren's3 "vasoregulatory asthenia," Gorlin's4 "hyperkinetic heart syndrome," or Frohlich's5 "hyperdynamic β-adrenergic circulatory state." One wonders whether the doctor's choice of the appropriate label can serve as his screening test for recertification.
Whatever its label, the symptom-complex characterized by palpitation, dyspnea, precordial pain, fatigue, exaggerated emotional responses with increased cardiac awareness, and occasionally, systolic hypertension, often presents a diagnostic and therapeutic dilemma, as well as a