GPs urged to tell patients about the ‘cardiac blues’

Neelima Choahan

29/05/2018 2:21:23 PM

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.
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.

Cardiac-Blues-Article.jpgAndrew 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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Dr ArshadcMerchant   1/06/2018 6:44:10 AM

There are number of problems in this scenario
1- post CABG he was followed in secondary and tertiary care where his care was medicalised
2- his post CABG medications in particular beta blockers have severe side effect of depression, vivid dreams etc
3- why the psychological side was not address during his cardiac rehabilitation
4- GPMHP is not the answer here ... This is a classic example of system failure that traumatise this patient who is now 5 years post CABG has lost a lot.
5- He is not suffering from depression but seems like PTSD. I will request that the author shall ask his primary care physician as well as his psychologist to address this please. We may be able to save one life

Dr Peter J Strickland   1/06/2018 11:04:50 AM

The findings from this research are nothing new, and were well known in the 1960s in my student days. Anyone undergoing any procedure such as triple bypass will think deeply about their experience of vulnerability to sudden or gradual demise. The effects of anaesthesia, medications taken, constant discussions with others about their close encounter etc. all add up to the development off anxiety and depression --it is a form of PTSD, and often comes on months after the traumatic event. But also applies to women with respect to breast cancer, patients who become paraplegic from an accidents etc.etc., and it is a normal and long-known consequence of patients suffering major or minor medical events, and not only heart problems. The only other factor with respect to the heart and the onset of mental problems is that there is a definite close association between the heart and the brain (one's personality) as revealed by heart transplant patients sometimes taking on the personality of the person who has died and was the heart donor.

Chris Hogan   1/06/2018 9:07:08 PM

There is nothing new about this.
I am no stranger to confronting my mortality having survived meningococcal septicaemia, being shot at in the course of my duties & a few other incidents. However, 15 years ago without any prior warning, I had atypical chest pain 2/10, a feeling of dread & cold, profuse sweating. This came on after I went for a 400 metre walk , settled with rest & returned after I walked 400 metres back home. I was hospitalised via ambulance & although serial ECGs & cardiac enzymes were normal, but a cardiac angiogram which showed almost total occlusion of the LAD. I had bypass surgery 36 hours later
The surgeon was very frank about the emotional & psychological sequelae so that when they occurred I was prepared. Sadly, I was not immune.
As had been no warning & the symptoms had been so vague, I could no longer ignore the usual aches, pains & twinges of a sedentary 50 year old.
So I had lots of trips to my long suffering GP, cardiologist & ED. Sometimes it was asthma (in spite of my pedantic use of preventers), sometimes referred pain from my arthritic spine & sometimes straight out anxiety. The therapy helped & I became adept at unobtrusive relaxation exercise & a regular visitor to my physiotherapist.
I shared my experiences with all of my patients who needed cardiac surgery & mentioned it to my students, registrars & colleagues

Dr Duncan MacWalter   2/06/2018 8:37:45 AM

"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..."

Why doesn't the author 'push' for the single-organ specialists to consent and counsel their patients about the psychological impacts of their conditions and procedures?
Rather than another Ivory Tower researcher deciding GPs are 'ideally placed', or 'need additional training', why doesn't the researcher focus their drive on the hospital specialists, and their wider MDT team, to have a better understanding of the biopsychosocial model of health?

Bill mcneil   4/06/2018 3:27:39 PM

Remember Cancer is the same. Any of my patients with heart attack or cancer i tell them- just like chest pain, just like chemo.. mood changes are an indivisible component of the syndrome- and that after all the adrenaline and the fight or flight component winds down- I’ll be there- and I’ve got a plan. Seems to be well received so far.

Betsy   9/02/2021 10:05:36 PM

My husband had triple bypass 1 month ago. He is not the same man. All the symptoms in this article are very real. Wish there was a publication I could give him to read or 1 for me as guidance

Kathy   3/03/2021 3:17:35 PM

After my heart attack I have symptoms of high norepinephrine/epinephrine - insomnia, agitation, anger. Clonidine (which stops the production of NE) relieves them to some extent. The agitation plus depression at the loss of my former way of life are often unbearable. Read about neurohormonal activation. It's NOT in your head. Or mine.
It's in the literature - heart failure + depression. But there is no effective or accepted treatment. SSRIs, the mainstay of depression treatment, are ineffective and possibly dangerous.
This is a biochemical and lifestyle issue and it needs to be addressed.

Annie   21/03/2021 5:07:38 AM

My husband had 4 way heart by pass at 47 , although he did not have a heart attack, but this saved his life. I noticed changes after , that he was grouchy, Then at 74, he had a heart attack , nothing medically was done.
Dr. Said he was ok.
At 77 a major heart attack, did a 4 way by pass, then opened him again 1 hour after, Dr said he was bleeding! But he nicked a lymph node, another Dr. tried to fix it for 7 hrs. but it didn’t work. Hubby is now 79 yr. and complains about everything. He feels good though.he has always been slim, after the surgery I cook plant base, now he yells he wants to gain weight, and it’s my fault. But he said he has never felt better, and loves the food. Btw, we are not always perfect, but do eat healthy.
I have talked to other women who’s hubby has had heart bypass, same story, there nasty and grouchy after forever. Just gets worse.
I’m ready to leave him. I hate living this way.

Thank you.

Hilary   17/05/2021 4:19:05 AM

For over 25 years after my husbands heart attacks and then quadruple bypass, life has never been the same. No one informs the wife or family that the person coming back to them will be so very different. Anger is an understatement, it’s anger on steroids. shouting, screaming, throwing things and hitting out. No one tells you this is what you will face when you get them back. It’s ok talking about the person having the condition and getting the treatment and why they are angry...but seriously...No one tells you what the partner, wife, children etc. will have to cope with. It’s so hard, this is the person you love and adore and he in my case is not the same person. You can love him but not actually like, especially when he can be very abusive. My husband is very sick and I will do everything I can to help him but it’s so very hard and sometimes soul destroying. I feel like I’ve lost me in this journey and no GP or cardiovascular surgeon ever tells you about the consequences.

Fred   24/11/2021 4:35:27 AM

Pity None of this was explained, I went to a doctor about short term memory loss. I did not recognise the personality change. I had a CABG operation. Wife left me because of issues decribed above. I quite frankly I became sucidal because if these issues. Seems little point in living anymore. This needs to be recognised and explained to both parties.

Lucienne Rodrigue   4/05/2022 12:48:58 PM

I wishes. My surgeon told me about my husband surgery that his personality will. Be different I just read about it cardiac blues

Anthony Goldsmiith   7/12/2022 4:50:47 PM

After over a year since having open heart surgery I have been undergoing mind games for which I have had no real explanation and which have come so close to costing my wife of 60 years and I our marriage. GP service seems to have become more remote since the pandemic and nothing about 'cardiac blues' was ever explained by the cardiac team charged with my post op care. So, like so many folk it seems today, the only form of help was from my little smart phone which I am posting this on now after learning from it at 5 in the morning why I have been undergoing such strange feelings and picking through events in my life that occurred nearly 70 years ago.

It is hard to believe just how badly the NHS have failed me in even mentioning the mental effect that open heart surgery could have for even months after the operation. I am so grateful that perhaps I can now see my condition as something that hopefully I can begin to deal with.

Karen Wade   6/02/2023 3:54:36 PM

This is a tragic omission from the profession for aftercare for my husband’s 4-way bypass. All off the above discussions happened to the max to our family. Now we have a very guarded relationship with the main daughter who cared for us. His PC, Cardiologist, and now Vascular Dr.s have not warned us or provided mental health aftercare for the patient and family. This is not fair since marriages and relationships are at great risk because of this negligence to care for the whole person, especially since it is well known, and no literature given to the patient or family on what to expect and how to cope!! Thank you! Karen Wade

Sharon Clark   15/10/2023 11:31:24 PM

I had an ablation 6 months ago and talking with my partner over the past couple of days about my opinionated negative disposition of late. I know I’m doing and cannot believe what comes out of my mouth at times. I said I feel I have been like this since the ablation. I had been very sick beforehand. Thankyou. Maybe I am not going crazy. I know now and hopefully I can save my relationship before it is too late.