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Mitralklappenprolapssyndrom und Herzneurose — eine Pseudokorrelation?

  • G. Paar
  • H. Schmid
  • C. Schmidt
Part of the Jahrbuch der medizinischen Psychologie book series (MEDPSYCHOL, volume 1)

Zusammenfassung

Die vorliegende Studie steht im Zusammenhang mit neueren Untersuchungen zu einer klinischen Fundierung des HAS. Angeregt durch neue pathophysiologische und pathobiochemische Befunde sowie durch die Berücksichtigung pharmakologischer wie auch verhaltenstherapeutischer Behandlungen wurde die Zuordnung von Angstzuständen zu den Neurosen in Frage gestellt. Aus der Suche nach „biologischen Markern“wurde die Hoffnung abgeleitet, über eine differenzierte diagnostische Betrachtung zu differenten Therapieverfahren zu gelangen. Diese Überlegungen stützten sich u. a. auf Hinweise, die bei Patienten mit Angstattacken signifikant höher als bei Kontrollen einen MVP zeigten. Die dabei erhobenen Prävalenzen in mehreren Studien lagen z. T. erheblich über dem Vorkommen des MVP in der Allgemeinbevölkerung.

In der vorliegenden Studie wurden medizinische, physiologische und psychologische Daten an 18 Patienten mit Herzneurose, 16 mit MVPS und 14 Kontrollprobanden erhoben. Nach den kardiologischen Befunden und den Interviewdaten lassen sich die beiden Untersuchungsgruppen gut voneinander trennen. Nach unseren Ergebnissen gehören Herzneurose und MVPS 2 voneinander abgrenzbaren unabhängigen klinischen Syndromen an.

Die in den vorliegenden Studien zur Assoziation von HAS und MVP gefundenen hohen Prävalenzen werden zunächst aus den unterschiedlichen Zuweisungen der Patienten wie aus den unterschiedlich angewandten Kriterien der Festlegung eines Prolaps im Ultraschall zu verstehen sein. Zum anderen geben Autoren neuerer Arbeiten zu bedenken, ob mit dem Herzultraschall ohne Beachtung weiterer klinischer Befunde lediglich eine Normvariante der Mitralklappe beschallt wurde. Damit wären die meisten Patienten, die in der Literatur zu den hohen Prävalenzen beitrugen, entweder Herzneurotiker oder schlichtweg Gesunde.

Abstract

The present study is related to recent surveys collecting clinical data in support of the concept of “Herzangstsyndrom”, heart anxiety syndrome (HAS). New pathophysiological and biochemical findings and consideration of pharmacological treatment and behavioral training led to doubts as to whether states of anxiety could be counted as neuroses. Consequently, the search for “biochemical markers” raised hopes that a more differentiated diagnosis would bring about new forms of therapy. These considerations were — among other things — supported by the observation that mitral valve prolapse was found significantly more often in patients with anxiety attacks than in controls. This high prevalence was confirmed in several studies and proved to be considerably higher than the occurrence of mitral valve prolapse in the general population.

The present study compares the medical, physiological, and psychological data of 18 patients with heart neurosis, 16 patients with mitral valve prolapse syndrome, and 14 controls. The two groups of patients are clearly distinguished by cardiological findings and interviews data. Our results show heart neurosis and mitral valve prolapse syndrome to be distinct and independent syndromes.

The high rate of prevalence found in the present studies on the association of HAS and mitral valve prolapse syndrome must be understood to be a result (a) of different allocations of patients and (b) of the fact that the criteria for identifyng a prolapse by means of ultrasound are far from uniform. Moreover, other authors have recently raised the question whether sonography of the heart performed without regard to other clinical findings could simply have revealed normal variants of the mitral valve. If this were true, most of the patients who have caused the high prevalence rates given in the literature would either be heart neurotics or simply healthy people.

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Copyright information

© Springer-Verlag Berlin Heidelberg 1988

Authors and Affiliations

  • G. Paar
    • 1
  • H. Schmid
    • 2
  • C. Schmidt
    • 3
  1. 1.Klinik für Psychotherapie und PsychosomatikRheinische Landes- und HochschulklinikEssenDeutschland
  2. 2.KreiskrankenhausFrankenberg/EderDeutschland
  3. 3.BundeswehrkrankenhausGießenDeutschland

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