Cardiac arrhythmias are “electrical” problems of the heart. These result from disturbances to the heart’s natural pace-making and electrical system. Examples include atrial fibrillation, long QT syndrome, ventricular tachycardia or ventricular fibrillation. Patients may take medications to control the heart rate or rhythm (e.g. beta-blockers, antiarrhythmics) or to prevent strokes (blood thinners like warfarin or novel anticoagulants, “NOACs”, like dabigatran, apixaban, rivaroxaban). Patients may also undergo cardioversion or ablation to control arrhythmias, or have implanted devices such as pacemakers or ICDs (implantable cardioverter-defibrillators).
Psychology and Cardiac Arrhythmias. Medical and surgical treatments for arrhythmias have become increasingly sophisticated and effective. Yet people with arrhythmia may face depression, anxiety, and emotional challenges in adjusting to their condition. They may be very anxious about their symptoms.
Not all arrhythmias are life-threatening, although some are, such as ventricular tachycardia or fibrillation. Not surprisingly then, arrhythmic episodes can be emotionally disturbing or traumatic. Arrhythmias can be associated with anxiety, panic or psychological trauma with symptoms such as flashbacks, nightmares or a sense of helplessness. Such symptoms may be connected to a threatening cardiac event actually experienced by the patient, or to some other past trauma in that person’s life. Repeated ICD shocks can be very disturbing, and may be followed by fear, panic, trauma, and feelings of losing control over one’s life.
From research evidence, and in my clinical experience, psychological treatment can be helpful in assisting people to adjust to their arrhythmia, and in providing relief for psychological complications related to depression, anxiety, panic and emotional trauma.
Congenital Heart Disease
Congenital heart disease involves “structural” problems of the heart present at birth. Some congenital abnormalities may create cyanotic (“blue”) conditions in which a person sometimes cannot get enough oxygen, due to inadequate heart pumping efficiency and blood flow. Adult patients may have had corrective heart surgery in infancy or childhood for conditions such as Tetrology of Fallot. Later in life some individuals may develop other heart conditions, such as cardiac arrhythmias. These in turn may be managed with medications or ICDs.
Psychology and congenital heart disease. Compared to some cardiac conditions, there is less research evidence about the psychology of congenital heart disease. Heart patients with surgically corrected congenital abnormalities very often have good long-term psychological adjustment and quality of life as adults.
In my clinical experience, psychological complications of congenital heart disease sometimes occur when patients have faced early challenges or traumas in childhood, or when new medical complications arise in adulthood, such as arrhythmia. Careful psychological assessment and treatment may be helpful for difficulties such as emotional trauma, panic, depression, or problems in family or intimate relationships.
Cardiomyopathy involves abnormal growth of heart muscle. It can have different causes, including genetics, high blood pressure or viral infections. Sometimes the cause is unknown. Cardiomyopathy or repeated heart attacks may lead to reduced pumping efficiency of the heart, and to congestive heart failure, in which fluid is not adequately cleared from the lungs or other areas of the body. Patients with cardiomyopathy or congestive heart failure may be treated by their heart doctors with drugs (e.g. digitalis, diuretics, beta-blockers or others) or surgery, or may have implanted devices such as ICDs.
Psychology, cardiomyopathy and heart failure. While we need more psychological research in this area, we do know that depression is very common among patients with heart failure. Heart failure patients may also have mild cognitive (i.e. information processing) impairments, such as problems with memory, or “executive functions” like goal-setting, planning and organization.
Depression and cognitive impairments may complicate medical management and lead to worse outcomes. It is very important that heart failure patients learn effective self-management of their illness. That is, they need to gain knowledge, skills and confidence about key points of care such as self-monitoring of symptoms, weight changes, and medication use, to be able to work effectively in partnership with their doctors and other healthcare professionals.
My own clinical experience includes working with cardiomyopathy and heart failure patients to assist them with anxiety, panic and depression.