by Carolyn Thomas ♥ @HeartSisters
As I have written here earlier:
“There are few life events more stressful, in my considered opinion, than surviving a heart attack.
“Not only is the actual cardiac event a traumatic and overwhelming experience in itself, but what very few cardiologists tell us before they boot us out the hospital door is how debilitating the day-to-day angst about every subsequent bubble and twinge can actually be.
“I can recall, for example, feeling virtually paralyzed with fear over unexpected chest pains following my heart attack (symptoms, I later learned from my cardiac nurse, that are often called “stretching pain” – common in coronary arteries with recently implanted coronary stents). These frightening symptoms can last for weeks.”
Yet even among those survivors who don’t experience distressing symptoms like these, the severe emotional blow that lingers after a cardiac event can be shockingly debilitating to many.
That’s why there is actually no such thing in reality as a “small” heart attack.
Now, for a straightforward clinical example of rating a cardiac event, California cardiologist Dr. Daniel Lee Kulick illustrates how doctors might assess the severity of a heart attack – usually to help predict how much time is required for the dead heart muscle that’s been deprived of oxygenated blood flow during the attack to complete its scarring process:
“After a small heart attack (little damage to heart muscle), patients usually can resume normal activities after two weeks. A moderate heart attack (moderate damage to heart muscle) requires limited, gradually increasing activity for up to four weeks, while a large heart attack (much damage to heart muscle) may result in a recovery period of six weeks or longer.”
This fairly straightforward and practical prognostication of a patient’s back-to-work timeline, however, completely misses the boat when it comes to acknowledging the profound psychosocial impact of surviving a heart attack – no matter how much physical damage to the heart muscle has occurred. A heart attack is simply so unlike any other health issue.
This lack of medical attention to the profound psychological impact of a cardiac event is significant.
As Dr. Gilles Dupuis of the Université du Québec and the Montreal Heart Institute reported in the May 2010 issue of the Canadian Journal of Cardiology, post-traumatic stress disorder following heart attack is an under-diagnosed and often unrecognized phenomenon that can actually put survivors at risk of another attack.There are, of course, individual differences in recovery depending on a broad range of factors.
And recuperation from a heart attack or any traumatic cardiac condition cannot be compared to that experienced in the world of acute medicine where recovery from surgery or other treatments can often be realistically plotted, barring unforeseen complications.
When I went through four months of cardiac rehabilitation, a man in our group bragged to the rest of us one day that he was now golfing three times a week. I felt both thunderstruck and dismayed, because he had undergone triple bypass surgery about the same time as my own heart attack happened. I had not had bypass surgery, yet was barely able to function from day to day. How could he possibly be happily playing golf already?
One of the differences may have been that he had not actually experienced a myocardial infarction (heart attack); his surgery had been done as an elective procedure related to angina symptoms in order to possibly ward off a future heart attack.
Meanwhile, I had survived a misdiagnosed heart attack that then resulted in ongoing cardiac issues including Inoperable Coronary Microvascular Disease.
Some patients, on the other hand, experience massive heart attacks, cardiac arrest or other life-threatening events and yet seem to proceed calmly through an uneventful recovery.
Overall, doctors have dismissed the unique mental health issues of heart patients for far too long. An Israeli study* out of Tel Aviv University’s Sackler Faculty of Medicine, for example, examined the association between depressive symptoms in heart attack patients and subsequent hospital admissions more than a decade after the initial attack. The January 2012 study’s results were troubling:
“Heart attack patients who suffer mental health issues as a result of the attack are more likely to be re-admitted for cardiac events and chest pains in the future, and have 14 percent more days of hospitalization than their counterparts.”
Patients who are struggling emotionally after the trauma of a heart attack can also be far less likely to successfully make post-op lifestyle changes like regular exercise, smoking cessation or heart-healthy eating. In fact, the Israeli researchers found that patients who suffer depression following a heart attack were:
- 20% less likely to be physically active
- 26% less likely to participate in a cardiac rehabilitation program
- 25% less likely to quit smoking
So it can become an endless vicious circle loop of:
“Feel bad→ Don’t exercise→ Keep smoking→ Poor eating choices→ Feel bad!”
As the Israeli researchers concluded:
“The message is that doctors cannot ignore psychological factors in patients who have had a heart attack. Patients who exhibit signs of depression need to be followed more closely, and may need extra help in following lifestyle recommendations.”
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See also:
- The New Country Called Heart Disease
- Chest Pain of Angina Comes in Four Flavours
- Squishing, Burning and Implanting Your Heart Troubles Away
- 10 Non-Drug Ways to Treat Depression in Heart Patients
- ‘Heart Attack & Soul’: the Perfect Gift for the Heart Attack Survivor
- How We Adapt After a Heart Attack May Depend on What We Believe This Diagnosis Means
- “What Was That?” A Poem for Heart Attack Survivors
- Women’s Heart Pain is Both Physical and Emotional
- Why Hearing the Diagnosis Can Hurt Worse Than the Heart Attack
j* Vicki Myers et al. “Post-myocardial infarction depression: Increased hospital admissions and reduced adoption of secondary prevention measures — A longitudinal study.” Journal of Psychosomatic Research, Volume 72, Issue 1, January 2012, Pages 5-10.
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People, do NOT take these risks.
My dad, a very happy, athletic fit guy, went to a cardiologist one afternoon and was told his heart looked great. He was thrilled. He then did some very physical activity that evening, and died the next morning suddenly from a massive heart attack. Out of the blue. Did not even see it coming. Everyone was shocked. I still can’t believe it.
DO NOT take any of these risks people, please, no matter how much people brag. It’s not worth it.
My condolences to you on the tragic loss of your Dad, Stephanie. It can indeed be hard to accurately predict cardiac outcomes – especially in fit, athletic people.
Carolyn, agree 100% with you. There is NO such thing as a “small” heart attack; doctors who treat patients dismissively with this phrase do them a disservice while undervaluing the very real psychosocial impact of a cardiac event.
The medical profession has not yet caught up with the literature that clearly confirms how psychologically traumatic cardiac events can be. Thx for your comment here, Calista.
This article has such truth to it. Even though I have not survived a heart attack personally, several immediate family members have and I have tried my best to be their support system with information and encouragement because they were so emotionally fragile. Not to mention that I was a pharmaceutical rep and I sold a beta blocker.
The emotional devastation was talked about with the physician as quality of life factors. To see the percentage of people that actually spiral down from those factors are not surprising. I would like to see specific care units and advisement that could be offered in the physicians office or at the hospital in a very aggressive and proactive way. I think this might give more people help.
As usual this was a great article that gave insight not only to those who have been affected but also for those who are trying to understand and gain insight.
Thanks so much for your perspective, Katrina – and also for reminding us that it’s not just the patient who struggles with the emotional burden of a chronic and progressive illness like heart disease.
Hi Carolyn,
I too think it’s great that you wrote this article. If you don’t mind me asking, how old are you? The reason I ask is … I am 48 and had a “mild” heart attack the end of May this year (2012). If one more Dr. including the ones in the hospital who saw me for 2 seconds during my 3 day stay say “You are too young for this to happen to you”… I am what? Going to give up, feel more terrible, scream, have another heart attack. Grrrrrr
Symptoms were not severe at all, actually I was probably experiencing them for a few days before going to the ER. Including during my son’s birthday party the day before! Going for a followup appointment was more than frustrating when I was told the cardiologist who performed my “Procedure” could not see me until September and yet right after my “procedure” said: “I hope to see you in my office many time over next 50 yrs”.
I was also told by office staff on way out of seeing NP “there is list of people more important for him to see, sorry.” I said to them with tears in my eyes and a lump in my throat, “Well, I had a heart attack, it’s kind of important to me” as I left the huge waiting room of grandmas and grandpas, feeling so alone and sad.
I did end up seeing the NP for 3 weeks followup for a what seemed like one track typical, quick appt as though I did not have a heart attack. I left the office thinking, you aren’t going to give me an EKG or xray or anything to see if I am OK? You aren’t going to ask if I have any questions? And then the Dr office called me about a week later – maybe from my asking for Dr. and raising a fuss? idk.. asking if I’d like a followup appt with Dr in a week! I saw him and he said the infamous “You are too young for this to happen” and I just about lost it.
I left him, sad again, with several scripts for medicines I hesitate to take. I have been taking plavix since my “mild” heart attack, in addition to my normal BP meds, and more. At end of appt I did manage to hesitantly ask if there was a support group for people like me. He gave me a card of someone to call about info. I said “are they too young like me?” ..
Thank you for making me feel like I am not alone.
Thanks for your comment, Beth. I hope you did contact that support group. (But your story does make you wonder why hospital staff wouldn’t be passing out those cards before patients are discharged from the cardiac unit instead of waiting until patients have to ask for info much later on their own!)