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Cardiac pain can arise when, in a patient's unconscious, receptive impulses conflict with combative ones or with anxiety. It is well known that oral impulses cause vagal stimulation as in eating and digestion or as in noxious stimulation of the gastrointestinal tract. Vagal stimulation of the gastrointestinal system by reflex action slows the heart and redistributes the blood away from the skeletal musculature and into the splanchnic area for the purposes of digestion. It also probably constricts the coronary arteries and arterioles. If this anabolic type of circulation with vagal preponderance is suddenly disturbed by rage or fear, or both, the increased sympathetic stimulation interferes with the vegetative balance. This can result in a functional disturbance of the heart which may lead to ischemia and cardiac pain. Psychoanalytic data are given to illustrate such emotional reactions.
Psychotherapy should be aimed at diminishing the patient's oral guilt and anxiety arising out of hostility or competition, as well as encouraging him to slow down his reaction time to receptive stimuli.