The Intersection of Mental Health, Cardiac Crises, and CPR Education

Jun 1, 2023

Recovering from a heart attack, cardiac arrest, or major heart surgery involves not only physical healing but also mental and emotional well-being, which can often be overlooked. Experts emphasize that issues like depression, anxiety, and post-traumatic stress not only affect patients but also have a direct impact on their recovery.

Julie Cunningham, a clinical health psychologist at Samaritan Medical Group in Corvallis, Oregon, who works with cardiac patients, stresses the importance of addressing depression for both mental health and cardiac well-being. Patients with depression tend to have slower recovery rates after heart surgery, making it challenging for them to engage in crucial rehabilitation programs like cardiac rehab. Additionally, a depression diagnosis following a heart attack has been linked to a higher risk of death, according to a study published in the European Heart Journal – Quality of Care and Clinical Outcomes in 2017.

Mental health disorders can manifest after various cardiac conditions. Studies have shown that depression or anxiety affects over 30% of individuals who undergo aortic heart valve replacement and 30% to 40% of those who undergo heart bypass surgery.

Different cardiac experiences pose unique mental health risks. Dr. Sachin Agarwal, director of the NeuroCardiac Comprehensive Care Clinic at Columbia University in New York, explains that survivors of heart attacks, where blood flow to the heart is blocked, may experience symptoms such as chest pain or shortness of breath and may develop post-traumatic stress disorder (PTSD). Around 1 in 8 heart attack survivors experience post-traumatic stress.

People who have suffered even minor strokes often describe feelings of terror, and nearly 1 in 4 stroke survivors experience PTSD a year later, as per a study published in the American Psychologist in 2018.

Those who have undergone cardiac arrest, where the heart suddenly stops, may wake up days or weeks later in an intensive care unit (ICU) with no recollection of what transpired. About a third of cardiac arrest survivors experience PTSD symptoms and as many as half exhibit signs of depression at the time of hospital discharge.

Psychological distress in cardiac arrest survivors has been extensively studied, revealing that individuals experiencing PTSD symptoms often exhibit anxiety, hypervigilance, difficulty concentrating or sleeping, and avoidance of places or behaviors that remind them of the traumatic event.

Agarwal further notes that heart surgery can lead to cognitive problems in addition to mental health issues. Prolonged hospitalization can contribute to conditions known as post-hospital syndrome or post-ICU syndrome, which encompass a range of physical and psychological challenges.

Numerous biological connections between depression and heart disease have been identified, and a cardiac crisis can trigger a host of emotional issues. Patients may fear a recurrence of sudden health problems or feel despondent due to worsening long-term conditions. Their physical abilities may be diminished, preventing them from working or participating in hobbies and exercise as they used to.

Roles can also reverse, with caregivers suddenly becoming the ones in need of care. This shift can pose risks for caregivers themselves.

Cunningham highlights that a cardiac crisis can significantly impact the family unit. In her experience, she observes that patients come to visit with loved ones more often than any other patient population. Loved ones may feel stress as they desire to help with the recovery process but are unable to control the situation. Adult children may also be taken aback when they discover they could inherit a condition that jeopardizes their own health.

Agarwal points out that family members of cardiac arrest survivors may experience a distinct form of trauma. Since most out-of-hospital cardiac arrests occur at home, family members often find themselves in a position of calling emergency services, administering CPR, making difficult decisions, and wondering if their loved one will recover.

While survivors of cardiac crises face existential concerns as they come to terms with what happened and worry about the future, witnesses - often close family members - carry memories of the entire ordeal and grapple with classic symptoms of PTSD, such as flashbacks. In fact, studies have shown that family members of cardiac arrest survivors may experience even higher levels of distress than the survivors themselves, as reported in a review published in the journal Resuscitation Plus in March.

The emotional challenges faced by loved ones can also have an impact on the health of the heart patient if it hinders the caregivers' ability to provide the necessary care. Recognizing the far-reaching effects of mental health on cardiac recovery, Dr. Agarwal and other researchers are actively exploring ways to predict mental health issues in cardiac patients and incorporate families into the healing process.

Dr. Agarwal emphasizes the need for healthcare systems to proactively provide resources to families and patients rather than leaving them to seek help on their own. The responsibility lies with medical professionals to ensure that equitable access to resources is available to those who need them the most.

Cunningham shares similar sentiments, emphasizing the importance of having conversations with patients to help them connect the dots and recognize the presence of depression and anxiety. Patients and their families need to understand that these mental health challenges are common and do not reflect any personal shortcomings. Acknowledging and addressing these issues is a crucial step toward holistic recovery.

The mental well-being of individuals recovering from cardiac crises is as important as their physical health. Depression, anxiety, and post-traumatic stress can significantly impact recovery rates and overall cardiac health. Healthcare providers need to prioritize mental health support, offer specialized programs like cardiac rehabilitation, actively involve families in the healing process, and also recognize the psychological impact of CPR during cardiac emergencies.

Additionally, promoting widespread CPR training and education within communities can empower individuals to respond effectively during cardiac emergencies, not only saving lives but also providing the necessary support for individuals to navigate the emotional challenges that can arise from such critical situations. By addressing both the physical and emotional aspects of recovery, along with comprehensive CPR training and education, we can enhance the well-being and quality of life of those affected by cardiac crises.

Source: https://www.heart.org/en/news/2023/05/23/why-a-cardiac-crisis-also-can-be-a-mental-health-issue Learn, Enjoy, and Save Life. Healthforce Training Center offers CPR Training and certifications such as Basic Life Support (BLS), Advance Cardiovascular Life Support (ACLS), Pediatric Advance Life Support (PALS), CPR AED, Pediatric First Aid CPR AED, and First Aid CPR AED.