Psychiatric disorders are reported to occur in up to 50% of heart diseases. Depression comes first among these. The connection between the heart and emotions has always been the center of attention in daily life, and many sayings about it have entered our daily language. Such as "heart breaking, heartless, heart narrowing, heart swell, heart heaving...".
The effects of psychiatric diseases on the heart have been referred to by various names throughout history.Nervous palpitation, irritable heart, exertion syndrome, such as cardiac neurosis. Especially type A (ambitious, hard-working) personality structure has been said to be a psychological condition that creates a predisposition to many heart diseases, especially myocardial infarction (heart attack). Nowadays, everyone knows that heart diseases occur due to stress and that it is necessary to live a stress-free life to prevent this. The psychiatric component is inevitably important in dealing with heart patients or patients with such complaints. Just as it is important to understand patients and make a correct diagnosis, it is also necessary to treat the existing psychiatric disease correctly and appropriately.
MYOCARDIAL INFARCTION (HEART ATTACK)
Anxiety is the situation that occurs in the first 24 hours after a heart attack. Upon admission to the coronary intensive care unit, the patient experiences anxious expectations and perceives the disease and its adverse conditions and the future as a disaster or threat. The main problem in patients is uncertainty, but 2% of patients experience uncertainty purely; It is experienced to a much greater extent as anxiety. When evaluated in terms of psychiatric diagnosis systems, this anxiety resembles GENERAL ANXIETY DISORDER.
Almost half of the patients report anxiety only when questioned, otherwise these patients are overlooked. The themes include the patient's fear of sudden death, addiction, loss of status and competence, and role changes or losses in sexual function relationships. On the other hand, heart surgery, the risk of a new infarction, loss of sexual functions and pain are the main fears of the patient. Considering that the patient already has type A behavioral characteristics, losing control His fear becomes even more dominant. But on the other hand, denial confronts the clinician as an important problem in the clinical environment. If the patient exhibits a denial that does not disrupt the course of treatment, that is, he only keeps away emotions such as fear, anxiety or distress associated with the disease, but on the other hand, it does not affect his compliance with clinical recommendations, this is exactly the desired situation; It serves a balancing function. However, if the patient exhibits insomnia in the clinical environment, removes the IV and goes to the toilet, smokes secretly, or eats prohibited foods instead of hospital food, then there is a situation that needs to be dealt with. In this case, instead of arguing with the patient, it is appropriate to approach the patient by respecting his efforts to keep anxiety away. However, the common behavior is to tell disaster scenarios to scare the patient even more in order to break the denial.
After 3 days of hospitalization, the denial gradually begins to break. But on the other hand, the patient comes to terms with the situation he/she encounters, perceives the limitations brought by the disease, and the perception of loss settles in. These feelings also drag the patient into depression. In the subacute evaluation of patients who have had myocardial infarction, approximately 50% DEPRESSIVE SYMPTOMS and 20% MAJOR DEPRESSION are detected. p>
DEPRESSION
Depression is known to be one of the leading causes that increase the risk of death from heart diseases. The psychiatric condition most common in heart diseases is depression. MASKED DEPRESSION, as it is called, in which physical symptoms are at the forefront, covers approximately half of the patients who apply to non-psychiatric clinics.
The risk of major depressive disorder in those with heart disease is 1.5- below normal. It varies between 4.5 times. The rate of pre-infarction depression in patients with myocardial infarction was found to be 27.5%, and this rate increases to 31.5% while hospitalized. On the other hand, the rate of myocardial infarction in depressed patients who are not treated adequately can increase up to 6 times the normal rate. Meat increases the risk These factors include loneliness, problems in interpersonal relationships and work stress.
The variable heart rate that develops in depression is suggested to be the leading cause of heart diseases and cardiac deaths that occur in mood disorders. Depression also impairs blood clotting.
Psychosocially, it can also worsen the course of heart disease. It prevents the patient from living a life suitable for heart disease (e.g. excessive smoking), reduces the patient's adherence to treatment, prevents the necessary examinations on time, disrupts compliance with rehabilitation programs (give up exercise), and prevents return to functionality.
As a result, the heart depression occurring in patients; It worsens the course, increases complications and increases the risk of death.
ANXIETY
Anxiety is a functional reaction in the body, which does not have any pathology under normal conditions. It is necessary for business success and assertiveness. However, excessive and prolonged anxiety leads to decreased work performance, burnout, symptoms of illness (most often heart disease) and the use of sedative medications. Anxiety, which has such an effect, negatively affects both the susceptibility to heart disease and the impaired physiology in heart disease.
Just like in depression, heart rate variability decreases in anxiety and the blood supply and rhythm of the heart are negatively affected. Anxiety is often accompanied by anger and hostility in heart patients. Anxiety is one of the main emotional problems that heart patients need to deal with, especially when it occurs together with other negative emotions. Especially anxiety or anxiety that develops after myocardial infarction both causes more complications and worsens the course of the disease (in terms of ischemia and arrhythmia).
PANIC DISORDER
In clinical practice, panic disorder and myocardial infarction may have the same symptom pattern. Panic disorder was detected in 15% of patients in whom coronary artery disease was suspected and therefore further examination was planned. In clinical practice, providing the most appropriate treatment as if the patient had a panic disorder is only possible if there is no coronary heart disease. It is necessary not to exclude man. It should not be forgotten that they can be confused with each other in the differential diagnosis, or they can be found together.
Cardiac symptoms form a separate cluster in the categorization of panic disorder. Agoraphobia is a higher rate in panic disorder with cardiac symptoms. In one study, 89%< of panic disorder patients. /strong> Palpitations and other cardiac symptoms were detected. Panic disorder patients' sensitivity and fear of heart diseases lead to diagnostic confusion. It makes all heart diseases, including heart diseases, a nightmare. Three cardiac symptoms stand out in psychiatric pictures: Chest pain, palpitations and shortness of breath. These symptoms are directly reminiscent of heart diseases. Chest pain is a symptom found in 12% of all patients presenting for healthcare. However, an organic etiological factor can be distinguished in 11% of these patients, while the rest develop with psychosocial origin. The presence of palpitations in addition to chest pain brings the patient closer to the concern of heart disease.
“Feeling like the heart is going to burst out of its place, burning in the chest, heart pounding, pressure on the chest to the point of breathlessness, and feeling like dying” are among the commonly used descriptions of patients. are some. Cardiac complaints that appear suddenly, with or without any stress, suddenly disturb the patient. Chest pain was reported to be more significant in terms of its location, severity, and spread, its help-seeking behavior was more consistent, and it was reported to be more typical with no previous stressors. For this reason, the possibility of confusion on the part of the clinician is considerable.
SOMATIZATION DISORDER
Somatization disorder is a disorder that causes unexplained physical complaints and begins at a young age. Even though these symptoms are actually identified as pain, digestive system, sexual, pseudoneurological, this combination of symptoms can sometimes directly indicate a heart disease. Sometimes, unexplained physical complaints become increasingly It can gather around a disease and turn into a belief that the patient is not convinced about. This condition is defined as HYPOCHONDRIASIS.
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