“Doctor, are you sure these palpitations are nothing but anxiety alone?” a patient was asking me in the middle of the night. She used to call me at least once a week with some or the other symptoms related to the heart. Once she felt her heart is not beating at all, while on another day she felt her heart has broken into a furious gallop, her every discomfort felt around the chest region always traveled to her left shoulder. If she could have saved all the money she had spent till now on her ECGs, she might have bought the latest iPhone for sure. Despite all possible reports that declared her normal and the constant reassurance from cardiologists about her health, she could not be relieved of her anxiety about getting a heart attack.
In a cardiac OPD, these cases are more common than any other organic heart ailments. Thanks to Google and YouTube, as well as the social chatting apps like WhatsApp, the number is increasing every day. Another most common reason being the news of someone near and dear suffering with a myocardial infarction at a very young age.
In this brief article, we will try to see the practical challenges we face as a treating physician as well as the therapeutic as well as non-therapeutic ways of handling the cardiac neurosis.
It becomes difficult to manage such patients who often say, “Actually I know that this is all in my mind and I do not have any cardiac ailment, but doctor, I can’t control these thoughts and they REALLY make my life a hell. Can you give me something so that I won’t get these thoughts at all?”
This statement covers almost every challenge that this condition presents:
- The primary challenge is that despite our best counseling to explain how their anxieties are baseless, there is a cold reply from the patient that they “already know” what we are telling them. The problem is – “…but still i am suffering!”
- The demand of the patients is to get a MAGIC PILL to STOP these thoughts coming to their mind. Thus they want to have a readymade solution, in form of the pill, to get rid of this demon at once. The modus operandi that the patients have in their mind is to “prevent these thoughts coming to my mind” instead of handling them rationally later.
- Unsaid tone behind such statements, in most of the patients, is that you (physician) do everything that needs to be done – but get me out of this.
Handling the belief system:
Almost 80% problem lies in the mind (belief system). As we commonly describe, in Marathi, “कळतंय पण वळत नाही” is the main issue, which is known to the patient as well. This happens because despite we KNOW many things, we do not BELIEVE in them internally. We may overtly agree to ideal statements, right from doing regular exercises to ignoring silly thoughts that make us anxious, but we know how we fail to implement them.
There are two types of thoughts that we get – the first ones are the active thoughts which we actively do about a certain thing. While the other category is the AUTOMATIC thoughts, we all get without our will. Anxieties rise from these thoughts when they are dysfunctionally negative. While standing at the top of a sky-rise, almost all of us get the thought about “what will happen if I jump from here?” – but not each of us actively works on that thought to make it a reality or getting worried about it. That’s the difference. One can’t stop or avoid such thoughts coming to our mind since they are automatic, but with active efforts, we can learn to stop them ruining our mind later.
“THEN WHAT” strategy
In any case of anxiety, if you want to reach the core of the problem, go on asking “then what?” and you will reach the central cause of the anxiety. Let me give you an example – “Doctor, what if this is a heart attack?” – if it is then what – “I don’t want to die so young” – if you die young then what – “my kids are so small, who will look after them?” – Thus it is not the cardiac anxiety alone, but about the kids as well, equally significant one.
The best way to handle such anxieties is by going to such core anxieties and handling all of them one by one. The patient will not feel comfortable unless all said and unsaid anxieties are resolved.
The medicines – Homeopathy & Bach flower remedies:
Sudden and violent anxiety episodes with great nervous irritation and excitement. Every little trigger leads to great fear and anxiety of mind. Hasty patients. Thoughts arise from the stomach. Music makes her sad and is unbearable. Tossing about in agony, changing positions often. Fear of future and crowdy places. Talks about death and declares time too. Typically affected on waking with the feeling of suffocation.
ARS ALB :
Anxiety with mental restlessness, forcing the patient to move from one place to the another, but physically too weak to move. Fear of death. Fears about getting affected by incurable diseases. Sad and hopeless about recovery. Thoughts lead to exhaustion of mind. Fear and anxieties while alone. Dislike being in the situations that are out of their control. Will check each and everything multiple times to ensure nothing goes wrong. Want a doctor nearby if something happens to them.
Ailments from a bad news. Very effective when the cardiac neurosis starts after hearing any news of a friend or relative suffering from myocardial infarction. Restlessness with a fear that if they don’t move the heart will stop. Weak and slow pulse. Palpitations with dullness and drowsiness.
Exactly opposite to Gels. Feels if he moves, the heart will stop beating. Will sit listlessly for the fear of violent palpitations. The slow and weak pulse which is very irregular.
WHITE CHESTNUT :
A key remedy from Bach flowers for persistent thoughts that trouble the patient. The chaos of thoughts leading to insomnia, palpitations, and anxiety. Can’t get them out of the mind.
Fear of specific things like the heart attack or angiography.
Sudden episodes of anxiety without known cause as well as vague thoughts. Forebodings. Apprehensive.
RESCUE REMEDY :
For sudden panic episodes.
I have found infrequent (most of the times – STAT doses) of indicated remedy in 1M or 10M potency followed up with Bach flower remedies indicated for the symptom similarity gives the best results.
Dr Amit Karkare
BHMS, BFP (Bach Flower Practitioner)
Dr Amit Karkare has been practicing Homeopathy and Bach Flower Therapy for over a decade. As a research-oriented homeopath, Dr. Karkare has worked extensively in cases with Refractory Epilepsy, Cardiac Neurosis, and Plantar fasciitis.
At PRANA, he looks after the Cardiac Care specialty.