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Soldier's heart: the forgotten circulatory neurasthenia - a systematic review

Guilherme Passamani Borges1, João Henrique Almeida Tonon1, Pablo Andres Alves da Silva Zunini1

  • 1Health Secretariat, São Bernardo do Campo, Sao Paulo, SP, Brazil.

International Review of Psychiatry (Abingdon, England)
|May 28, 2020
PubMed

Insights

Soldier's Heart (SH), a historical diagnosis, is proposed for inclusion under posttraumatic stress disorders (PTSDs). This systematic review supports this by examining SH's clinical practice, symptoms, and treatments.

Area of Science:

  • Psychiatry
  • Cardiology
  • Military Medicine

Background:

  • Soldier's Heart (SH) is a historical medical diagnosis with declining usage and controversial removal from DSM-5.
  • Current clinical practice shows inadequate use and diagnostic overlap with other conditions.
  • SH is associated with significant physical symptoms, including cardiological comorbidities.

Purpose of the Study:

  • To systematically review the clinical usage of Soldier's Heart.
  • To evaluate the diagnostic criteria, military stress association, and treatment of SH.
  • To support the reclassification of SH under posttraumatic stress disorders (PTSDs).

Main Methods:

  • Systematic literature search of 19 studies.
  • Data collection on diagnosis, military stress, heart rate variability, treatment, and prognosis.
  • Analysis of diagnostic overlap and clinical practice.

Main Results:

  • Inadequate use and diagnostic overlap of Soldier's Heart were identified.
  • SH is linked to physical symptoms, generalized anxiety disorder, and PTSD.
  • Higher prevalence of cardiological comorbidities and potential consequences in SH patients.

Conclusions:

  • The study supports including Soldier's Heart under the umbrella of posttraumatic stress disorders (PTSDs).
  • Physical symptoms are key features associated with generalized anxiety disorder and PTSD.
  • Pharmacotherapy (benzodiazepines, beta-blockers) and non-pharmacological treatments (biofeedback, mindfulness) are beneficial. Further research is needed for psychopathological domains and novel treatments.

Keywords:
Da Costa’s syndromeSoldier’s hearteffort syndromefunctional cardiovascular diseaseneurocirculatory asthenia

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