May 28, 2021

Mental Health After a Cardiac Event or Procedure

The connection between heart health and mental health is familiar to patients and medical professionals around the world. One of the many instances of this connection comes from the fluctuations in mental health people may experience after surviving a cardiac event or undergoing a procedure.

Danielle Henkel, a cardiologist at the Loma Linda University International Heart Institute, delineates why and how patients may develop a range of immediate or chronic mental struggles, such as anxiety, depression, or post-traumatic stress disorder (PTSD), after a cardiac event or procedure.

Why do cardiac events or procedures place a strain on mental health?

Fear and uncertainty play into a patient’s efforts to process what transpired after a cardiac event, like a heart attack or undergoing certain cardiac procedures. Patients may have limited memory of the event or struggle with comprehending new medical terminology used to describe their procedure.

In many cases, cardiac events are abrupt and unexpected, with certain procedures taking place quickly after that. "All this leaves the patient little time to process what is happening to them, and that can be traumatic," Henkel says. Even if the patient is aware of an upcoming scheduled cardiac procedure, they may feel mounting anxiety as they juggle unknowns such as what to expect and how the procedure will work.

Coupled with the unsettling mental strains are often disagreeable physical sensations themselves, Henkel says. The cardiac procedure may be uncomfortable, even from the standpoint of needing to undress for sterilization before a procedure. Moreover, if a patient is already feeling poorly from their underlying heart disease, new events or procedures can further amplify strain and stress.

What are the different ways people may experience mental health struggles after a cardiac event or procedure?

Henkel says it is common for people who survive a cardiac event or procedure to struggle mentally: about one in five will develop a serious form of depression, while one in three will come away from the experience with anxiety. “The depression or anxiety could become a second diagnosis alongside your cardiac diagnosis,” she says.

Almost immediately after a cardiac event or procedure, people begin to grapple with what just happened to them and start to contemplate how their life may be different in the future. Henkel says patients’ minds can spin through a mental carousel of questions: How has this affected my health? How will this impact my finances and work situation? Will this alter family dynamics as roles change?

The patient’s loved ones or members from their social support network may also share immediate reactions of shock, stress, confusion, and even guilt, with such thoughts as: Should I have seen this coming? What did I miss? Could I have prevented it?

The initial whirlwind of emotions — shock, fear, grief, sadness, fatigue — and difficulty processing can persist in the long term, Henkel says, developing into chronic feelings of hopelessness, helplessness, or struggle with sleeping and concentration. Depression after a cardiac event or procedure sometimes lowers that person’s inclination to take their cardiac medications, to withdraw from support, or turn to coping mechanisms that might further harm their health.

“Some people are able to address their initial reaction to a cardiac event or procedure, but there is a potential for post-traumatic stress to evolve if they are not able to address it or don’t know how to address it as they move forward,” Henkel says.

Do any factors place someone more at risk of struggling mentally post-cardiac event or procedure?

A number of factors may place someone at higher risk of developing mental health struggles after a cardiac event or procedure, including a pre-existing history of anxiety, depression, or prior trauma; and living under financial strain or socio-economic stress. Others may be comorbidities and previous illnesses such as diabetes or obesity; and living alone or not having a built-in support system.

Henkel says that factors such as age, culture, and gender do not sway someone’s likelihood of struggling mentally after a cardiac event or procedure. In this sense, she says, these post-cardiac event or procedure mental tolls form a universal experience shared by many.

How can someone who survived a cardiac event or procedure boost their mental recovery?

Henkel advises patients to prioritize their self-care, which they can achieve in a number of ways. Patients should ensure they get enough sleep, refrain from overcommitting to stressful tasks, and relax their mind and body with activities like reading and mindfulness, as well as exercise to “sweat out the stress.” Eating a healthy, balanced diet, especially a plant-based diet, has proven effective in helping people feel better physically and mentally.

Engaging in forms of talk therapy with someone they trust or a professional who is not integrated into their immediate social network can also be relieving for people. The same goes for caregivers to the person recovering from the cardiac event or procedure. Caregivers may experience significant stress as their lifestyle shifts to account for the recent incident. Henkel advises caregivers to express their own needs honestly and stay receptive to new forms of support.

Building support among family members or social groups, whether in-person or online, is also beneficial for event and procedure survivors' mental health. Cardiac rehab, for instance, allows people to focus on healing in a comfortable group setting surrounded by others with similar stressors. A care team and patients work together on exercise and discuss tips for healthy living such as diet and mental health. People can also bring their family members to cardiac rehab sessions, allowing them to listen and understand how to best support their loved one.

Henkel advises patients to talk to their cardiologist and doctors openly about how they are feeling, both physically and mentally. They shouldn’t hesitate to ask questions or review potential side effects from medications. On the other hand, ditching medications can lead a patient to have recurrent symptoms or end up back in a hospital.

It’s also possible to independently address the anxiety or depression people may feel after a cardiac event or procedure with medications prescribed by a physician — whether they be for a short or long term — Henkel says. When all else fails, she says, the medications allow patients to rise above crippling mental struggles and enable a frame of mind for the patient to engage in self-care or take their first steps toward healing.

The original version of this commentary was posted on the Loma Linda University Health news site.