title: Cardiac Munchausen syndrome.
abstract: OBJECTIVE
  To examine the reports on cardiac Munchausen syndrome for clinical characteristics.
  
  
  METHODS
  Cases, case series, and related articles on the subject in all languages were identified through a comprehensive literature search.
  
  
  RESULTS
  Fifty-eight cases of cardiac Munchausen syndrome were identified. Mean +/- SD patient age was 44 +/- 12 years (range, 23 to 71 years). Fifty-four patients (93%) were men. The most common presenting complaint was chest pain simulating acute coronary syndrome (86%). Syncope and dyspnea were also reported. Mostly, these patients were admitted directly from the emergency department to the coronary care unit. Acute myocardial infarction was the most common admitting diagnosis. The other admitting diagnoses were cardiac arrest and arrhythmia. The average number of hospital admissions for cardiac symptoms was 6 per patient (range, 1 to > 29 admissions). Numerous procedures including cardiac catheterization, coronary angiography, peripheral arteriography, permanent pacemaker placement, electrophysiological studies, intra-aortic balloon insertion, pulmonary artery catheter insertion, and electrical cardioversion have been performed in these patients. Twenty-four patients (41%) had history of undergoing prior multiple invasive procedures, but only 10 of these patients admitted having undergone these procedures. Ninety-five percent of patients altered their stories, with many leaving the hospital against medical advice when confronted with possibility of cardiac Munchausen syndrome as the correct unifying diagnosis. None of the patients reported for follow-up.
  
  
  CONCLUSIONS
  Cardiac Munchausen syndrome results in unnecessary investigations and organ damage from unneeded aggressive procedures. There is scarce information available on the prognosis of these patients, especially in the long term.
authors.affiliation: Division of Cardiology, Department of Medicine, Creighton University School of Medicine, Omaha, NE 68131-2044, USA.
authors.forename: Nirav J
authors.initials: NJ
authors.lastname: Mehta
authors.forename: Ijaz A
authors.initials: IA
authors.lastname: Khan
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009110:Munchausen Syndrome / Q000453:epidemiology