36 cases of children with cardiac neurosis were treated to alleviate symptoms. 18 cases recovered within 1 to 2 weeks, 14 cases were cured within 3 to 4 weeks, and four cases showed no significant improvement despite various treatments. Follow-up (recovery) was conducted on 29 cases over a period of 6 years; in 17 cases, the primary symptoms reoccurred, and in four cases, symptoms recurred after treatment alleviation. Cardiac neurosis, also known as cardiovascular neurasthenia, labor syndrome, or DaCosta's syndrome, has neurological and psychiatric factors playing a prominent role in its pathogenesis, but the exact pathophysiological mechanism is unclear. There has been an increasing trend in recent years, especially among children, which may be related to their academic stress.
The data shows that school-age children accounted for 72.2% (26/36); the male-to-female ratio was 2:3 (14/22), and mental factors (academic pressure, anger, severe stimulation, etc.) were present in 27 cases, accounting for 75%. The misdiagnosis rate was as high as 55.6%. This group mainly received symptomatic and psychological treatments, leading to a good prognosis with a cure rate of 88.9%. Some patients are prone to relapse, and poor outcomes in four cases might be related to physical conditions.
This disease is easily misdiagnosed, with up to 80% of this group being misdiagnosed with myocarditis. The reasons are twofold: (1) most pediatricians lack knowledge about this disease; (2) the diagnostic criteria for myocarditis are too lax, leading to the diagnosis of myocarditis based on mild abnormalities in ECGs and/or slightly elevated enzymes, even when ECGs and cardiac enzymes are normal, resulting in misdiagnosis and mistreatment. Cardiac neurosis is not uncommon in clinical practice, and as long as we raise awareness of the disease, it can be diagnosed in time, reducing unnecessary economic and mental burdens on patients.