Do you feel anxious, stressed, or depressed after your cardiac event or after being diagnosed with a heart condition? In this blog, we look at the relationship between psychological stress and heart disease and what you can do about it.
Following a cardiac event, 1 in 4 people are affected by depression, many of which are diagnosed with significant depression. In some conditions, such as heart failure, depression is even more common.
Having a cardiac event can be frightening and cause significant distress to the patient and their family members. The most common psychological reactions to a cardiac event are anxiety and depression. This is completely normal. Anxiety after a cardiac event can be short-lived and typically increases when a patient is discharged from hospital after an acute event and returns home – also known as “homecoming depression” – which usually resolves after a four month period.
We’re all in this together!
Partners are often as distressed as patients after a cardiac event so anxiety and depression can affect them too. It is important that partners are included in the cardiac rehabilitation process. Attending education sessions about physical activity after a cardiac event can reassure partners what activities are safe or unsafe. Learning about recommended dietary changes can help with good decision making with food shopping and preparation to enhance recovery.
In the groundbreaking EUROACTION trial (https://www.escardio.org/The-ESC/Press-Office/Press-releases/The-EUROACTION-Trial) partners of coronary or high risk patients (defined as a spouse, partner or significant other living in the same household) participated in the full assessment and 16-week cardiac rehabilitation programme. These patients went on to have measurably better health outcomes at the end of the cardiac rehabilitation programme and at 1 year follow-up.
In previous studies, researchers found that individuals find it hard to adhere to recommended lifestyle changes and prescribed treatments on their own. This includes smoking cessation, diet changes, increasing physical activity, weight management, blood pressure, cholesterol, and glucose level management.
Including partners in the rehabilitation programme means the patient is not alone in trying to make necessary lifestyle changes. Their active involvement made a significant difference in their outcomes, especially in relation to changing eating habits and increasing physical activity levels. EUROACTION helped both patients and their families benefit from healthier lifestyles.
Energy conservation and pacing
A major source of stress and anxiety following a cardiac event relates to being able to carry out normal day to day activities when symptoms like fatigue and breathlessness are still limiting your energy levels. Energy conservation and pacing strategies are important to help you adjust to any short or long term changes to your functional capacity.
Energy conservation principles include:
▪ Planning (set out a plan for what needs to be done)
– Set out what needs to be done for the day
– Break tasks down into stages to allow for breaks
– Eliminate unnecessary steps of a task
▪ Prioritising (assess what needs to be done)
– Make decisions about what the most important tasks are for the day
– Learn to say no to tasks that are not a high priority. This may include saying yes to the request but at a time that is more suitable for you or only saying yes to some of the request that can realistically be achieved.
▪ Pacing (be willing to allow more time for tasks and activities)
– Allow more time to do tasks
– Slow down when experiencing symptoms of breathlessness
– Alternate tasks that are more physically demanding with tasks that are less physically demanding
– Take regular breaks throughout the day
– Take breaks during a task rather than only taking break at the completion of a task or when exhausted
– Have sufficient rest after completing a task and before moving onto the next one
▪ Positioning (assess what positions increase energy expenditure and adjust them accordingly)
– Sit down to complete activities whenever possible
– Keep arms straight and close to the body while carrying objects
– Spread loads between both arms at the same time where possible
– Reduce time spent in static positions
– Reduce time spent on activities requiring work above shoulder height
– Avoid or minimize time spent in postures that impair breathing such as bending over
▪ Positive Attitude
– Focus on what you can do rather than on what you are unable to do
– Be aware and focus on functional improvements made since your cardiac event
If you would like to speak to a trained professional about your psychological health and wellbeing in the context of your heart condition you can contact the Irish Heart Foundation for relevant support services at:Irish Heart Foundation
orThe Psychological Society of Ireland
Written by James Murray, Cardiac Physiotherapist