Psychosomatic Medicine 15:38-60 (1953)
© 1953 American Psychosomatic Society

Emotional Stress in the Precipitation of Congestive Heart Failure

¹ Division of Clinical Physiology, Department of Medicine, and the Department of Psychiatry, University of Cincinnati, College of Medicine, cincinnati, Ohio; Present Address: Department of Medicine, Dartmouth Medical School, and the Hitchcock Clinic, Hanover, New Hampshire
² Division of Clinical Physiology, Department of Medicine, and the Department of Psychiatry, University of Cincinnati, College of Medicine, Cincinnati, Ohio; Present Address: Army Medical Service, Graduate School, Neuropsychiatry Division, Walter Reed Army Medical Center, Washington 12, D.C.

In a study of the precipitating events connected with episodes of congestive heart failure in 25 consecutive hospital admissions, emotional stress played a major role in 76 per cent. From a consideration of the patients' personality structures and their verbalizations, it was evident that these time-correlated life situations had strong emotional meaning. This unexpectedly high incidence of precipitating factors related to emotional stress may, in large part, be explained by the circumstances of the study, in which the patients were interviewed with a warm and helpful approach at a time when they were experiencing acute and overwhelming fear of death. This situation seemed to result in a dramatic lowering of psychological defenses. Material which otherwise would have been guarded was freely confided. This experience was associated with no deleterious effects to the patients; in some instances it seemed to have a beneficial influence on their physiologic status. It was observed that loss of security through rejection by some key figure upon whom the patient was dependent constituted an overwhelming threat for the patients in this series, and that this stress was common to the various life events responsible for the precipitation of failure in the group studied.

This was also observed in the longer studies, in which compensation was maintained as long as the patient-physician relationship was satisfactory; but as soon as this relationship was threatened, the patients again developed congestive heart failure.

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