by Carolyn Thomas    ♥   @HeartSisters

 I can vividly remember those early days and weeks at home after surviving a misdiagnosed heart attack, especially that cold creeping anxiety around how I “should” be feeling. I had just survived what many do not, what doctors still call the widow maker heart attack. (By the way, note the gender semantics there, please:   doctors are not, after all, calling this the “widower maker”).

I was now resting comfortably, both of my darling kidlets had flown back home to be with their Mum, our home was filled with flowers, get-well cards and casseroles delivered by concerned friends, family, neighbours and co-workers.

Shouldn’t I be deliriously happy and thankful now because I was alive, because I was so lucky to live near world-class cardiac care (and at no charge because I live here in Canada), and because I had a social support network of family and friends around to fuss over me?

Why was I so frighteningly tearful over every twinge I felt in my chest? Why was it becoming almost impossible to concentrate or to participate in conversations or to even drag my sorry ass out of bed every morning?  Why was I no longer interested in, well . . . anything?

Ironically, being surrounded by so much love and attention actually made me feel even more broken: with all this caring, how dare I feel anything but a good patient’s appropriately cheerful dose of gratitude?

This post is Part 6 of a 10-part summer series called “What I Wish I Knew Back Then”  which revisits some of the most common questions asked by freshly-diagnosed heart patients.  For example, it turns out that the post-heart attack depression I was experiencing is actually remarkably common among new heart patients. When I was at Mayo Clinic five months later, I was shocked to learn there that many heart patients experience new-onset depression, yet fewer than 10% of us are appropriately identified.

The type of depression that occurs so frequently after a serious health crisis (like any cardiac diagnosis) is known as “situational depression” or “stress response syndrome”.  It’s what mental health professionals call an adjustment disorder that can strike within weeks following a traumatic life event as we struggle to make sense of something that makes no sense. The only silver lining is that, unlike clinical depression, it’s typically temporary and treatable.   See also: 10 non-drug ways to treat situational depression in heart patients

But before I was discharged from the hospital after my heart attack, not one person in the CCU (the hospital’s intensive care unit for heart patients) had warned me of any of this.- Not one doctor, not one nurse, not one janitor had said even one word to me about this very predictable problem. I was sent home with a folder of heart-healthy recipes, info on wound care and a follow-up appointment with the doctor who would become my regular cardiologist. Nobody said to me:“This awful, scary, confusing way you feel IS NOT FOREVER. You are not alone! It will get better!”

It’s important for cardiologists and cardiac nurses to talk openly and early to their heart patients about this common cardiac companion if they expect us to be able to follow their basic instructions, quit smoking, exercise, take our new cardiac meds as prescribed, create a heart-healthy food plan, manage a healthy weight, or make any other required lifestyle improvements.

People who are depressed are unlikely to be able to follow instructions like those.

Unfortunately, many heart specialists may not have the time or the expertise to address depression, according to cardiologist Dr. Sharonne Hayes, founder of the Mayo Women’s Heart Clinic:

   “Cardiologists may not be comfortable with ‘touchy-feely’ stuff. They want to treat lipids and chest pain. And most are not trained to cope with mental health issues.”

But when cardiologists ignore the known risk of depression in their heart patients, it can have devastating consequences. A study published in the European Journal of Cardiovascular Nursing on depression in women with coronary artery disease, for example, found that 74% of women diagnosed with post-cardiac depression still had impaired physical and social functioning one year after their heart attack.(1)

That impairment also meant that overall recovery, independence and quality of life was also impacted.  Had I known in advance before I left the hospital that situational depression is common, temporary and treatable, I wouldn’t have felt so overwhelmed when symptoms began. Had I known in advance, I wouldn’t have worried that I was losing my mind.

Depression is particularly common among those diagnosed with heart failure, affecting up to 40% of all such patients. As described at the 2015 European Society of Cardiology conference, depression as a result of simply hearing this diagnosis  (“Your heart is FAILING!”)  is associated with:

• loss of motivation
• loss of interest in everyday activities
• lower quality of life
• loss of confidence
• sleep disturbances
• change in appetite with corresponding weight change
• a 5-fold increased mortality risk

So wouldn’t it just make sense for physicians to address these common depression symptoms in advance instead of labeling such people “non-compliant“ because they aren’t following doctor’s orders?

But depression in heart patients has “flown under the radar for far too long”, concluded the cardiovascular nursing study author, Dr. Colleen Norris. She added that doctors must look for symptoms of depression in ALL patients who are undergoing treatment for heart problems – and particularly in women.

We also know that the age of a heart patient may be an important factor here.(2)  For example, Dr. Susmita Mallik of Emory University School of Medicine reported in the Archives of Internal Medicine that younger women diagnosed with heart disease before the age of 60 are three times more likely to become depressed than male heart patients. Dr. Mallik observed:

“Depression should not be considered a normal reaction after a heart attack. Both doctors and patients should be aware that depression is an important risk factor for adverse outcomes for cardiac event survivors.”

If this temporary situational depression persists every day for more than three weeks straight, it’s time for heart patients to seek immediate professional help.

But I knew nothing about this kind of scenario at the time.

Doctors, next time you’re seeing a freshly-diagnosed heart patient for a follow-up appointment, please remember that we’re more than just a major organ that’s successfully undergone a procedure.

It’s time to start paying attention to the real-life emotional, mental and psychological trauma embodied in the whole person sitting across from you.

©Carolyn Thomas   ♥  Heart Sisters

1.  Colleen M. Norris et al. “Depression Symptoms have a Greater Impact on the 1-Year Health-Related Quality of Life Outcomes of Women Post-Myocardial Infarction Compared to Men”. Eur J Cardiovasc Nurs June 2007 vol. 6 no. 2 92-98

2.  Susmita Mallik et al, “Depressive Symptoms After Acute Myocardial Infarction: Evidence for Highest Rates in Younger Women,” Archives of Internal Medicine 2006; 166: 876-883.

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I wrote lots more about situational depression associated with heart disease in Chapter 6 of my book, “A Woman’s Guide to Living with Heart Disease”. You can ask for it at your local library or favourite bookshop, or order it online (paperback, hardcover or e-book) at Amazon, or order it directly from my publisher Johns Hopkins University Press (and use their code HTWN to save 30% off the list price when you order).

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