IN RECENT YEARS it has become apparent that a number of patients with serious cardiovascular disease are being mistakenly referred by their internists to psychiatrists. In turn the latter search vainly for the correct psychiatric diagnoses when, in fact, they should reallocate the patient in order to secure for him specialized and intensive medical investigation. A simple medical evaluation in these situations is unlikely to uncover the correct state of affairs. Hence, the patient will be as far from help as before he or she consulted not one, but at least two, physicians considered to be relatively expert.
There are certain symptoms in cardiovascular disease which may exist without objective confirmation or ready explanation and hence are often assigned to a functional nonpathologic origin. In particular there are two groups of patients, those with intermittent complete atrioventricular (AV) block