CARDIOPATHIA FANTASTICA: WATCH OUT WHEN DECEPTION INVOLVES THE HEART

The Cardiac Variant of Munchausen also known as Cardiopathia Fantastica has rarely been reported in the literature. Knowledge of its existence would be not only beneficial for a patient’s workup regarding his/her complaint, but also would be economical to the hospital by reducing unnecessary medical tests as well as procedures. Herein, we report a case of cardiopathia fantastica initially presented as a social admission to Veterans’ Affairs (VA) hospital due to lack of housing leading to an extensive cardiac workup including coronary angiography secondary to his deceiving cardiac complaints. A 56-year-old male with history of Diabetes mellitus, Coronary artery disease, Hypertension and Polysubstance abuse (in full remission) was admitted to the VA hospital as a social admission due to lack of housing. He remained asymptomatic during the initial days. After few days in the hospital, the patient complained of severe chest pain 8-9 out of 10, precordial location associated with difficulty breathing and uneasiness. Patient underwent electrocardiogram (EKG) and troponin levels to rule out an acute cardiac event. It turned out that the patient had slight elevation of troponin and a decision was made to transfer the patient to another institution for angiography for further evaluation that eventually was found normal. On reviewing past records, it came to our attention that the patient had undergone multiple angiographies in past for similar complaints at various hospitals. The patient had also received a pacemaker for an unreported reason. This case projects light on the futile nature of such a situation. Considering cardiac symptoms, complaints by patients would be detrimental if ignored or overlooked. At the same time, going overboard with numerous tests and procedures to rule out a cardiac cause can be expensive, overwhelming and possibly positive reinforcement for the patient exhibiting such a complaint. An understanding attitude towards such patients is particularly difficult because their entire problem is so bizarre. Feelings of resentment and an unmasking ceremony that sets the patient up, as an adversary should be avoided. Patients could benefit from long-term psychotherapy.