Feature
GPs urged to tell patients about the ‘cardiac blues’
Most patients who develop a sudden heart problem experience some form of emotional, cognitive and behavioural changes. Now a heart health researcher is behind a renewed push urging GPs to warn their patients about it.
Dr Barbara Murphy, Principal Research Fellow at the Australian Centre for Heart Health, wants GPs to discuss the emotional impact of a cardiac event with their patients.
After undergoing a triple bypass open-heart surgery, Andrew Pike recovered his physical health quite rapidly.
But even after more than five years, the now 72-year-old can still feel the aftereffects on his mental health.
‘In the hospital I was given very good physical support and I was told that the surgery would serve me well for 20 years. So my physical recovery was extremely rapid,’ Mr Pike told newsGP.
‘But I went back to my cardiologists on three occasions to say that something wasn’t right, that I was suffering from depression, mood swings, that I was getting nightmares.’
According to the Australian Centre for Heart Health, 55,000 Australians have a heart attack each year.
Dr Barbara Murphy, the Principal Research Fellow at the Australian Centre for Heart Health, said 80% of patients who undergo a sudden heart procedure, such as acute myocardial infarction, acute coronary syndrome and coronary artery bypass graft surgery, experienced some form of the ‘cardiac blues’, including anxiety, anger, tearfulness and frequent nightmares.
She said one in five patients go on to experience depression, which is much higher than the general population’s rate of one in 20.
‘Basically, in the weeks and first few months after their cardiac event they just have a gamut of changes that are emotional, behavioural, cognitive,’ Dr Murphy told newsGP.
‘It’s really an emotional rollercoaster and they are generally not aware that it’s going to happen because no one has told them.
‘The patients are treated and handled really well [physically] when they have a heart attack or heart surgery, but there’s not really been a lot of support for them emotionally.’
Dr Murphy said patients often experience a lot of grief after the operation.
‘I think it’s like an existential crisis. It’s the first time they might have to face their mortality,’ she said.
‘The recovery period challenges their ability to get back to work, it might challenge their relationship with their partner and with their kids, it challenges their identity.
‘There are also physiological mechanisms that are similar between depression and the cardiovascular system. So there is inflammation that occurs at the time of the heart attack that can precipitate depression as well.’
Dr Murphy led a 2015 research project, published in Australian Family Physician, which showed that while 81% of the 160 patients interviewed at two Victorian hospitals would like to have received information about the ‘cardiac blues’, only a minority received it.
Dr Murphy is now behind a renewed push for GPs to understand and be at the forefront of spreading awareness about the emotional and psychological fallout from the surgery.
‘I initiated the project five years ago and received funding from beyondblue to develop the resources for patients and health professionals,’ Dr Murphy said.
‘About four out of five patients do experience the cardiac blues, and what we want to do is normalise it and reassure patients that it is likely to resolve in the first few months.
‘The heart event isn’t just a physical event, it’s an emotional event as well, and these things are likely to happen.’
However, Dr Murphy said in some cases the symptoms do not resolve and can develop into full-blown depression.
Andrew Pike, who had a triple bypass open-heart surgery in 2011, says the lack of information about the likely psychological issues after the surgery severely affected his life.
Mr Pike said he had never been a ‘depressive personality’ and instead was a ‘proactive, entrepreneur-type of person’, but after the operation seemed to lose his confidence.
‘I went back to the cardiologist and he basically dismissed what I was saying and said, “Oh, it is just intimations of mortality, you will get used to it”,’ he said.
‘So we just thought, “Oh well, I will see it out”, but after six months it was still bad.’
Mr Pike then went online and started researching the ‘emotional aftereffects of open heart surgery’.
‘We found a wealth of information, a lot of academic papers on the subject including one … saying up to 70% of people who have open-heart surgery have some form of short-term or long-term emotional disturbance,’ he said.
Eventually, Mr Pike found a GP who helped him get a mental health plan and see a psychologist.
Mr Pike said even three years after the operation he felt psychologically affected, with his marriage breaking down under the strain.
‘I was still getting nightmares, panic attack, I was unable to take on work that I had been offered,’ he said. ‘It was extremely difficult. It affected my family relationships very negatively.’
Mr Pike believes that, had there been more information available after the operation about the mental health issues, he would not have effectively lost three years of his life.
‘My marriage would have been saved, I think, if my wife had been able to understand that what I was going through was not just self-indulgence or pig-headedness on my part, but a common reaction to the surgery.
‘Also, I would have dealt with it a lot differently too and seen it all as a common aftereffect.’
Visit the Australian Centre for Heart Health website for more information on ‘cardiac blues’ resources for patients and healthcare professionals.
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