Wednesday, October 26, 2011

Anxiety & Depression 1

When I began to write this article, I was thinking of the aspects of depression and anxiety that occur after a heart attack, and also after any serious life-threatening illness.  But I found that depression and anxiety can also lead to a heart attack.

So let me begin with the after effects.  Depression and anxiety do occur with many people after a major illness.  The depression is because they recognize, often for the first time, their own vulnerabilities and that they might die sooner than they had expected.  The anxiety occurs because they are entering the unknown.  They don’t know what is going to happen to them, both medically and elsewhere in their life.  Will their job still be there ?  Will they still be able to participate in all the things that they were able to do in their lives, only yesterday ?  Although age is not a requirement for depression and anxiety, age can exacerbate the issue.

Your symptoms may vary from day to day. You might have some phantom chest pains, which will scare you.  There will some things that you just can’t do yet. Simple things, like walking very far.  And you will be learning the new limits of your body.  And you will hate it, because you haven’t had these limitations before.

So, you will be tired, you can’t drive for at least a month, maybe three.  You friends and family will sympathize but they can’t really feel it like you can.

And depression and anxiety can make you short-tempered and angry.

Why do I feel anxious?

As many as 30% of patients report feeling anxious or depressed after a heart attack or heart surgery. When you arrive home, you  are expecting to start feeling better. Your feelings of anxiety may be due to a mixture of reasons. You may be worried that you're going to have another heart attack, or you may have doubts about the success of your operation. These fears are a natural reaction to the stress of the event; they often resolve as time passes. It takes time for the implications of the condition to sink in, and the uncertainty of work prospects may worry you.  Your friends and family will likely not be able to understand why you feel anxious; they think you should be relieved to be alive and on the mend.  And on your intellectual level, you feel this too.  But on the emotional level, you still have these feelings and they can last for long time.

Is it normal to feel anxious after a heart attack or bypass surgery?

Anxiety is common after a heart attack or heart surgery; up to one third of heart patients experience anxiety. Anxiety levels are highest in the first 12 hours after a heart attack. Many studies have shown that anxiety is more common in women than men after a heart attack or bypass surgery. For most heart patients, levels of anxiety return to normal after hospital discharge. If you can't shake your concerns, you may have an anxiety disorder. About half of anxious heart patients still experience symptoms up to a year after their heart attack.

Here are the symptoms of anxiety as outlined by the U.S. National Institute of Mental Health:
  • Unable to relax or concentrate
  • Easily startled
  • Fatigue
  • Headaches
  • Muscle tension and muscle aches
  • Trembling or twitching
  • Irritability
  • Sweating or hot flashes
  • Feeling lightheaded or out of breath
  • Nauseous
  • Going to the bathroom frequently
  • Trouble falling or staying asleep

Am I depressed?

You may experience fatigue, tiredness, irritability, or flairups of temper.  And these can happen quickly and unexpectedly. These could be signs of depression. Soon days will be better than others.  You will be tired and need naps.  These are important for your depression and the physical rebuilding of your body.  But even having these can depress you.  But don’t fight it.  Some cardiologists recommend having a short nap each day.  These naps can cut your risk of reoccurrence by a large margin.

About one in five people suffer from major depression after a heart attack, bypass surgery or angioplasty.  Some degree of depression occurs in up to a third of all heart attack survivors.  And, women generally experience more depressive symptoms than men after a heart attack or bypass surgery.

Here are the symptoms of depression as outlined by the U.S. National Institute of Mental Health:
  • Persistent sad, anxious, or empty mood
  • Feelings of hopelessness, pessimism
  • Feelings of guilt, worthlessness, helplessness
  • Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
  • Decreased energy, fatigue, being “slowed down”
  • Difficulty concentrating, remembering, making decisions
  • Insomnia, waking up early, or oversleeping
  • Loss of appetite and weight loss, or overeating and weight gain
  • Thoughts of death or suicide; suicide attempts
  • Restlessness, irritability
  • Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain 

Can depression affect my recovery?

Many studies have found that depression increases the risk of dying after a heart attack.  In women, depression appears to increase the risk of dying from a heart-related cause within the first year of a heart attack. The effects of depression can also last a long time; depression one month after surgery can be associated with the recurrence of chest pain up to 5 years later. If you're depressed, you may also be less likely to take your medicine or make the lifestyle changes prescribed by your healthcare provider.

What can I do?

As a survivor, you need to confront potential underlying fears and anxieties. You are encouraged to:
  • Be patient.  Anxiety and depression after a heart attack are usually  temporary.
  • Discuss feelings with your doctors, family and friends.
  • Keep a journal. Sometimes, writing about feelings can help a heart attack victim feel better.
  • Arrange for counseling if these persist for more than four weeks. .

Making friends and family aware of possible problems can help their understanding of your situation. It can also be reassuring for you and your family to know that problems are usually temporary.

You may like to join a cardiac support group as it can be useful to share your concerns with people who have been through the same experience. Contact your local heart association or your own doctor for direction
Rehabilitation programs are another excellent option. They provide information on healthy eating and managing risk factors for coronary heart disease; they also run exercise programs, and I will write about each of these in future posts.

Also available are counseling and stress relieving activities for people who have had heart attacks or heart surgery. You will usually be contacted by a rehabilitation nurse before you leave hospital. If you find it difficult to attend a rehabilitation program, you may be offered a self-help Heart Manual from your local hospital to use at home. It is important to discuss any problems with your doctor as he or she may be able to help you resolve your anxieties. If your anxiety or depression becomes severe, and there is no sign of improvement, you may need treatment from your doctor or a professional counselor or therapist

There may also be loss of libido or impotence for men, which may be due to anxiety or depression, the chest discomfort after surgery, or else due to certain medications such as beta-blockers or diuretics. If you think your medication may be affecting you in this way, ask your doctor about changing it. Your doctors are an excellent resource for you.  Don’t overlook this avenue.

Charles Spurgeon said it best: “Anxiety does not empty tomorrow of its sorrows, but only empties today of its strength”.

Thursday, October 13, 2011

You May Not Present as a Heart Attack to the Paramedics

We have likely all heard of the warning signs of a heart attack. And we didn’t pay attention. And that’s normal. Until you have one.

So, as you are reading this blog, you have an interest in heart attacks and that’s probably because you’ve recently had one, or someone you know has and you want to know more. Or, maybe you’re getting a bit older and want to be prepared.

The most common symptom of a heart attack is chest pain, usually described as crushing, squeezing, pressing, heavy, or occasionally, stabbing or burning. Although this pain can occur at any time, a great number of patients experience it in the morning, within a few hours after awakening. Chest pain tends to be focused either in the center of the chest or just below the center of the rib cage, and it can spread to the arms, abdomen, neck, lower jaw or neck. Sometimes, when a heart attack causes burning chest pain, nausea and vomiting, a patient may mistake his or her heart symptoms for indigestion.

So here are the normal warning signs of a heart attack. The body likely will send one or more of these warning signals:

  • Uncomfortable pressure, fullness, squeezing or pain in the center of the chest lasting more than a few minutes.
    • If you do experience chest pain and the pain is severe, you should seek immediate medical care. Even if the chest pain is not severe, emergency care is needed if the chest pain is crushing or squeezing or is accompanied by one or more of the following symptoms
    • shortness of breath
    • discomfort or tingling in the arms, especially the left arm
    • pain in the back
    • tightness or pain in the lower jaw
    • profuse sweating
    • fainting
    • nausea
    • lightheadedness or loss of consciousness.
  • Pain spreading to the shoulders, neck or arms. The pain may be mild to intense. It may feel like pressure, tightness, burning, or heavy weight. It may be located in the chest, upper abdomen, neck, jaw, or inside the arms or shoulders.
  • Anxiety, nervousness and/or cold, sweaty skin.
  • Paleness or pallor.
  • Increased or irregular heart rate.
  • Feeling of impending doom.
Not all of these signs occur in every attack. Sometimes they go away and then return again. If some of these symptoms occur, get help fast. For others, in the event of cardiopulmonary arrest (no breathing or pulse), call 911 and begin cardiopulmonary resuscitation (CPR) immediately. Your life or the life of someone else may depend on your actions.
However, you still may be having a heart attack and have different symptoms. One of these is sharp pain in the scapula (shoulder blade). This is not common and so, it is hard to diagnose as a heart attack. When the paramedics do arrive, they may do an EKG so that they will know how to best treat you and which hospital to take you to. And this still may not give the right indications. Here’s a question for you to review: Can pain in the jaw or teeth be an indication of a heart attack? The answer is yes. Heart pain can radiate to the jaw and teeth. It is more common for heart-related discomfort to affect the lower jaw than the upper jaw. It is important to know that a heart attack can have symptoms other than chest pain, and these symptoms should be checked immediately. Pain in the upper teeth also can indicate other conditions, such as a sinus infection. It's important to get evaluated by your doctor to know the cause of your symptoms. Remember:
  1. In 25% of adults, the first sign of heart disease is sudden death from a heart attack.
  2. In about 15% of cases, the patient never reaches a hospital for treatment and dies quickly after symptoms begin.
  3. How long heart attack symptoms last varies from person to person.
  4. Heart attacks strike almost one million people in the United States each year, causing almost 200,000 deaths.

In a future post, we’ll review what will happen when you do reach the hospital.

Saturday, October 1, 2011


This is the preliminary list of topics that I intend to blog about, probably over the next year. There is so much information about surviving a heart attack. If you have other topics that you would like me to cover, please send a comment or an email to drj at

You may not present as a heart attack to the paramedics
Heart attack vs heart disease
Could be physical or hereditary
Discuss depression & anxiety
Stents are not perfect
Have a health advocate to help you remember the answers at appointments
How to Maintain a Healthy Heart
Take control of your heart policy - your life depends on it
Ask your G.P. anything
Your G.P. has the capacity to find answers for you
Questions to answer your doctors (see my list)
Talk about some meds
Organize your meds - set timers to not miss meds
Your meds make you healthier than the next guy on the street
Educate yourself - books, pamphlets, internet
Advice to patient

The importance of fluid intake
Low sodium guidelines for heart failure
Sodium consumption for all ages
Stay away from processed foods - foods to avoid
The importance of weight control
If you exceed your diet numbers one day, it will affect you the next
Food recommendations
Recipe recommendations
Get help from a nutrition coach
Value of Blue Menu foods
Food values to watch (calories, sodium, cholesterol, fat)
Heartsmart cookbooks - beware of sodium values
Use measuring spoons as serving spoons
'Diet' doesn't have to mean bland food

The importance of exercise
Talk about the rehab track program & hands over the head
Get help from an exercise coach
Exercises (how much, which ones, re-hab, do it)
Heart needs aerobic exercise e.g. gym stick, recumbent bike
Get help from a walking partner

Your family has to understand how important a regimen is to you
Depression & Anxiety from any major illness
Keep a food and exercise diary
The importance of naps
The importance of stress
Sleep apnea
New wardrobe