Why a heart crisis can also be a psychological problem
The physical needs of a person recovering from a heart attack, cardiac arrest, or major heart surgery can be easy to understand. For many people, mental and emotional healing may be less pronounced.
According to experts, problems such as depression, anxiety and post-traumatic stress regularly affect not only patients but also their loved ones and have a direct impact on healing.
“Treating depression is important,” said Julie Cunningham, a clinical health psychologist who works with heart patients at Samaritan Medical Group in Corvallis, Oregon. “Not just for mental health — it’s actually very important for heart health as well.”
Patients with depression recover more slowly after heart surgery, she said.
“They’re going to have a harder time getting involved in and completing programs like cardiac rehabilitation, which are really, really important to their recovery,” she said.
And being diagnosed with depression after a heart attack can lead to a higher risk of death, according to a 2017 study published in the European Heart Journal – Quality of Care and Clinical Outcomes.
Mental health disorders can result from all kinds of heart problems.
Studies have shown that depression or anxiety affects more than 30% of people who have had their aortic valve replaced and 30 to 40% of people who have had heart bypass surgery.
Each heart condition presents a different type and level of mental health risk, said Dr. Sachin Agarwal, Director of the NeuroCardiac Comprehensive Care Clinic at Columbia University in New York.
Someone who is having a heart attack, in which blood flow to the heart is blocked, may experience chest pain or shortness of breath and may seek emergency treatment.
Agarwal, who is also an associate professor of neurology, said that one in eight heart attack survivors will experience post-traumatic stress.
According to a 2018 study published in American Psychologist, people who have suffered a mild stroke themselves report feeling anxious, and nearly one in four stroke survivors report PTSD a year later.
Someone who goes into cardiac arrest, where the heart suddenly stops, is unconscious while their life is at stake, but wakes up days or weeks later in an intensive care unit with no memory of how they got there.
A third will have PTSD symptoms, Agarwal said, and up to half will experience depression on discharge from hospital.
Agarwal, who studies psychological distress in cardiac arrest survivors, said that people who experience such PTSD symptoms often become anxious, show signs of hypervigilance, have trouble concentrating or sleeping, and avoid places and behaviors that remind them of the traumatic event remember.
Heart surgery can sometimes cause cognitive problems in addition to mental health issues, Agarwal said.
Prolonged hospitalization can lead to Post-Hospital Syndrome or Post-ICU Syndrome, umbrella terms that encompass a range of physical and psychological problems.
Researchers are aware of many biological links between depression and heart disease. And Cunningham said a heart crisis can trigger many emotional problems.
Patients may fear that a sudden problem will recur or may feel depressed when care is required because of a deterioration in their long-term condition.
You may be struggling with physical limitations. “You may not be able to work anymore,” she said. “They may not be able to pursue their hobbies or exercise to the same extent as they used to in the past.”
Someone who has always been a caregiver might suddenly be the one who needs care. And their caregivers are themselves at risk.
A common problem
A heart crisis “can affect the family unit in many ways,” Cunningham said. “Honestly, I see patients visiting me with their loved ones far more often than any other patient group I’ve worked with.”
Some loved ones, she said, may want to help with recovery but feel stressed because they are out of their control.
Adult children may be shocked to learn that they may inherit a disease that threatens their own health.
Agarwal said that when a cardiac arrest occurs, family members may experience a completely different trauma than their loved ones.
He found that most non-hospital cardiac arrests occur at home. It’s often a family member who calls 911, begins CPR, makes tough decisions, and wonders if their loved one will wake up.
While survivors face existential problems once they learn what happened and are more worried about the future, witnesses – mostly close family members – have memories of it all and still struggle with hallmarks of PTSD such as flashbacks.
Agarwal was the senior author of a review of previous research published in the journal Resuscitation Plus in March, which showed that in some studies, family members reported even higher levels of stress than cardiac arrest survivors.
He said such emotional issues could affect the heart patient’s health if it limited the nursing staff’s ability to care for them.
Cunningham said a mental health problem can come in many forms. Depression alone can be accompanied by a loss of interest in something a person used to enjoy.
It can also lead to irritability, frustration, or apathy. These may include problems sleeping or changes in appetite.
“It doesn’t have to be just sadness or depression,” she said, and all of those symptoms “can then make it really difficult to do the things we need to do to take care of our health,” like see a doctor Events.
According to Agarwal, cardiac anxiety in survivors often manifests as preoccupation with minor changes in physical symptoms, such as: B. an increased heart rate, combined with the inability to distinguish between threatening and non-threatening symptoms.
Cardiologists, he said, are used to receiving calls from patients whose only symptom is fear that “something is wrong,” whereupon doctors in the emergency room find no signs of trouble.
How to cope
For many patients, Cunningham said, a critical step in coping with such issues is completing cardiac rehabilitation, a specialized program that typically includes education about stress and emotional factors.
This includes supervised exercise, which has been shown to help relieve symptoms of moderate depression.
Cardiac rehab staff can also be a source of emotional support for patients, she said, and help with referral for therapy.
Heart rehabilitation also offers the opportunity to make contact with other heart patients. “It’s really important,” she said.
It can also teach about the recovery process and help “normalize the fact that these emotional reactions are common.”
For people not in cardiac rehabilitation, a cardiologist or family doctor can make suggestions for therapists, Cunningham said.
Her own counseling of patients often begins by encouraging them to return to everyday life as best they are physically able.
“While they’re recovering from the surgery, they may not be able to do as much as they did before the surgery,” she said. But things like getting up, getting dressed and having breakfast are also important.
“There’s a fancy term for that,” she said. “We call it behavioral activation.” It’s simply “the idea of getting people back into fun and meaningful activities to make them feel better, and it works.”
Agarwal said he and other researchers are actively exploring ways to predict mental health problems in heart patients and involve families in the healing process.
He said he was drawn into this area of research because families were desperate for help and it was clear health systems needed to do more.
“You can’t leave it to the families and patients to find us or to find the resources,” he said. “It’s up to us to find equitable ways to get resources into the hands of the people who need them most.”
Cunningham has had similar experiences. “I think sometimes medical teams assume patients know they have depression and anxiety because we see it,” she said.
“But it can be very powerful to have a conversation with patients and help them make sense of what’s going on, because maybe someone hasn’t told them.”
Heart patients and families need to be aware of how common depression and anxiety are, Cunningham said. “It doesn’t mean there’s anything wrong with you as a person. We know this is a really common reaction.”
Written by Michael Merschel.
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