Abstract
The referred to in 1864 by Hartshorne 1 as muscular exhaustion and in 1871 by Costa 2 as irritable heart syndrome, has undergone so many name changes that it is almost possible to date a physician by the name he selects. To an old-timer it may still be Da Costa syndrome; to a later graduate it may be neurosis, disordered action of the heart, soldier's heart, effort syndrome, or neurocirculatory asthenia; to a new arrival it can be Holmgren's 3 vasoregulatory asthenia, Gorlin's 4 hyperkinetic heart syndrome, or Frohlich's 5 hyperdynamic β-adrenergic circulatory state. One wonders whether the doctor's choice of the appropriate label can serve as his screening test for recertification. Whatever its label, the symptom-complex characterized by palpitation, dyspnea, precordial pain, fatigue, exaggerated emotional responses with increased cardiac awareness, and occasionally, systolic hypertension, often presents a diagnostic and therapeutic dilemma, as well as a
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