Portal de Periódicos da CAPES

Munchausen Syndrome

1999; Wiley; Volume: 245; Issue: 5 Linguagem: Inglês

10.1046/j.1365-2796.1999.00440.x

1365-2796

T O Cheng,

History of Medical Practice

D ear S ir, I read with interest the recent report by Harvey & Johnston [ 1] of two cases of cardiopathia fantastica, which is a cardiac form of Munchausen syndrome. The latter term was coined in 1951 by Asher [ 2] who gave the first detailed description of a group of patients with fictitious diseases. Baron Karl Friedrich Hieronymous von Munchausen was an 18th century Hanoverian cavalry officer who, in his retirement, recounted extraordinary and obviously exaggerated exploits of adventure and daring [ 2, 3]. These stories of miraculous adventures and feats made Baron Munchausen famous and were perpetuated by a succession of authors into the present century. Although, according to Asher [ 2], Munchausen syndrome is a common condition, it probably appears common because a single patient is seen so frequently by so many doctors [ 4]. Although Asher [ 2] described in his original article three varieties of Munchausen syndrome – laparotomophilia migrans (abdominal pain), haemorrhagica histrionica (bleeding), and neurologica diabolica (neurological symptoms), it was not long before a fourth variety was described by Kounis, in 1979, of cardiovascular presentations, under the name cardiopathia fantastica [ 5]. The drama and publicity associated with recent advances in cardiovascular diagnosis and therapy have led to an increased incidence of cardiopathia fantastica [ 6]. The most common presentation of cardiopathia fantastica, as in the cases reported by Harvey & Johnston [ 1], is simulated acute myocardial infarction or unstable angina, the so-called ‘Munchausen’ coronary artery disease [ 7] with or without factitious complications such as congestive heart failure, dysrhythmias and cardiac arrest [ 8]. These patients are often admitted directly from the emergency room to the coronary care unit and are often subjected to complex diagnostic and therapeutic procedures. Some of these patients went so far as to undergo coronary artery bypass graft surgery, illustrating the potential dangers of abuse of modern medical therapeutics [ 7]. Coronary angioplasty undoubtedly will be, or has been, performed [ 9] on some of these patients with coronary artery spasm. Unfortunately, neither coronary artery bypass surgery nor coronary angioplasty will cure cardiopathia fantastica. Finally, Munchausen syndrome is the preferred term to Munchausen's syndrome. The reason for use of the non-possessive form is that the person behind the eponym has no proprietary claim on the entity [ 10]. Certainly it would seem unnecessary to use the possessive before a sibilant as in Marfan syndrome [ 11]. Just imagine how many trees could have been saved by eliminating all the unnecessary apostrophes and ‘s’s. Received 4 June 1998; accepted 6 July1998.