What is “double heart disease”?
It is a combination of coronary heart disease and psychological illness. In fact, coronary heart disease is also a psychosomatic disease, and its development is closely related to anxiety and depression. Evidence-based medicine has confirmed that the combination of anxiety and depression in various types of coronary heart disease is indeed an independent risk factor for its prognosis. With the development of society, the number of people with coronary artery disease who have a combination of psychological disorders is increasing.
How do you get “double heart disease”?
The increasing social competition and the accelerated pace of life have led to increased psychological stress, resulting in an increasing number of psychiatric disorders. According to the findings of the World Health Organization, psychological disorders will become the second most common disease after cardiovascular disease by 2020. Cardiovascular diseases are closely related to psychological stress and psychological disorders caused by excessive psychological burden, and the two are mutually initiating factors, causal factors and affect each other, endangering health.
Depression and anxiety promote the occurrence and development of coronary heart disease and hypertension. Depressed patients often have abnormal regulation of hypothalamic-pituitary-adrenocortical axis function, sympathetic nervous system hyperactivity, decreased parasympathetic nervous system activity, and increased blood catecholamine levels, resulting in vasoconstriction, platelet activation, and increased heart rate, which are detrimental to the cardiovascular system.
Depression and anxiety also increase the risk of death and affect the prognosis of patients with cardiovascular disease. The main mechanisms are increased platelet activity, decreased heart rate variability, altered vegetative tone, decreased compliance with medical advice, and refusal to make lifestyle changes. It was found that depression increased the risk of death in patients with coronary heart disease by 1.24 times within 2 years and by 78% in the long term.
Having coronary heart disease can easily trigger depression and anxiety. Because coronary heart disease can cause severe angina pectoris, acute myocardial infarction and sudden cardiac death, it has a serious psychological impact on patients and causes a great stress reaction. Some patients do not know much about coronary heart disease, if coupled with insufficient communication between patients, it can bring negative emotions over time, such as tension, fear, sadness and pain, which cause enhanced sympathetic nerve activity in the body and trigger a series of psychophysiological changes, such as excessive secretion of catecholamines, disturbance of lipid metabolism, release of many kinds of pro-coagulant substances and thromboxane A2 with strong vasoconstrictive effect, accelerated heart rate and increased blood pressure, etc. This leads to a decrease in myocardial blood and oxygen supply and an increase in myocardial oxygen consumption, thus promoting or aggravating angina pectoris, arrhythmia, myocardial infarction and heart failure. General epidemiological survey data show that the prevalence of depression in hospitalized patients diagnosed with coronary artery disease ranges from 16% to 18%; in patients with acute myocardial infarction, the incidence of major depression ranges from 15% to 20%.
The prevalence of mild and moderate depression after infarction has also been reported to be between 45% and 55%. Depressive symptoms typically develop within a few days after an infarction and may persist or progress or heal for up to 3 months. 45% of post-infarction depression is de novo, meaning that more than half of the patients had a depressive state before the infarction and were triggered after the infarction. If not effectively controlled, patients with post-infarction depression have a 30% higher mortality rate and a 50% higher probability of having another cardiovascular event than non-depressed individuals.
It can be seen that fear of disease, fear of losing family and social support, loss of work capacity due to long-term illness or the economic burden caused by treatment are the main causes of negative emotions such as anxiety and depression in patients with coronary heart disease.
How to identify “double heart disease”?
According to statistics, in the clinical diagnosis and treatment, more than 90% of patients with coronary heart disease combined with psychological disorders are underdiagnosed. This is not only easy to cause over examination and over treatment, but also can seriously affect the quality of life and prognosis of patients with coronary heart disease. Patients with coronary artery disease who are not well treated by cardiovascular medicine specialists should be considered to have a combination of psychological disorders if the following conditions exist
Personality basis: easy to be sensitive and suspicious, thoughtful, or to do things in pursuit of perfection, often take things but can not put them down.
Psychological and emotional aspects: easy to worry and fear, nervousness and anxiety, irritability and agitation; or depressed depression, serious cases may have a sense of uselessness and hopelessness, low self-esteem, etc.
Behavioral aspects: sleep disorders are more prominent, including insomnia, early sleep, excessive dreaming; energy loss, fatigue without obvious reasons; easily frightened, afraid of noise, sensitive to sound; severe cases lack of interest in people and things, want to cry or cry easily.
Intellectual aspects: slow thinking, memory loss; inattention, unclear narrative expression.
Somatic symptoms.
1. Cardiovascular system manifestations: chest discomfort, non-cardiac chest pain, feeling of pharyngeal obstruction, paroxysmal palpitations, rapid heartbeat, unstable blood pressure, easy to fluctuate up and down, etc. This can be followed by other multi-system symptoms.
2. vegetative neuromuscular sensory system: headache and dizziness, muscle discomfort or pain, numbness of the limbs, trembling of the hands, easy sweating, blurred vision.
3. genitourinary system: frequent urination, decreased libido.
4, respiratory system: choking sensation, preference for big sighs.
5, digestive system: loss of appetite, no hunger, dry mouth, constipation, easy bloating indigestion, may have weight loss.
The corresponding clinical examination of the extent of the lesion does not fully explain the clinical symptoms caused.
How to detect “double heart disease” as early as possible?
First of all, every cardiologist is required to master the basic and necessary knowledge of bicardiac medicine, so that the signs and symptoms of psychological disorders in patients with coronary heart disease can be recognized and interpreted as early as possible.
Secondly, once suspicious symptoms of psychological disorders are detected, psychological scales are promptly used to determine them. Psychological scale is a very effective and important tool to detect patients with psychological disorders, and it is a “laboratory test” to identify psychological disorders. The Australian Guidelines for the Treatment of Coronary Heart Disease require that all patients with coronary heart disease should be screened for psychological disorders, but there are no such regulations in China, and the application of psychological scales needs to be promoted in clinical work.
Finally, for patients with coronary heart disease combined with psychological disorders that cannot be determined by the psychological scale, a consultation with a psychologist is requested. At present, some hospitals have established a system of double heart clinic and double heart check-up, which can help to identify whether patients with coronary heart disease are combined with psychological disorders at an early stage.
How to deal with “double heart disease”?
Because of the high mortality rate and poor prognosis of patients with coronary heart disease combined with psychological disorders, especially those with post-infarction combined with anxiety and depression, it is necessary to intervene in their combined psychological disorders. At present, the intervention treatment for the co-morbid psychological disorders of coronary heart disease focuses on the following three aspects.
1, psychological treatment: including two aspects, one is to establish a good doctor-patient mutual trust relationship. Heart attack is a kind of critical, urgent and serious illness, and the psychological burden of patients is very heavy. Medical personnel should be sympathetic to patients and give them uncompromising care and attentive attention. Medical personnel should use gentle language, skillful technique and kind sympathy to obtain the patient’s approval and achieve the effect of physical presence and psychological empathy. Secondly, the scientific knowledge of the relationship between psychology and disease should be educated. Doctors should instill basic knowledge about heart disease to make patients aware that positive and optimistic emotions and good behavior patterns can help in the treatment and recovery of the disease. Medical and nursing staff should adopt the way of listening, encouraging, persuading, inspiring and guiding, together with the means of brochures and network information, to psychologically help patients reacquaint themselves with the disease, reasonably explain the patient’s disease regression and prognosis, correct the patient’s unreasonable negative cognition and restore the patient’s self-confidence.
2.Anti-depressant and anxiety medication: On the basis of adequate treatment of coronary heart disease, the application of anti-anxiety and depression medication can significantly relieve patients’ psychological barriers and eliminate patients’ cardiovascular symptoms such as chest pain.
3.Physical exercise oriented comprehensive cardiac rehabilitation program treatment: Pay attention to the control of chest pain symptoms and the improvement of cardiac function in patients with post-infarction or acute coronary syndrome, and advocate early cardiac rehabilitation training, these measures are extremely important for the prevention and treatment of coronary heart disease combined with depression/anxiety. Exercise-based comprehensive cardiac rehabilitation program is a comprehensive clinical rehabilitation program integrating exercise physiotherapy, psychological counseling and therapy, vocational training, nutrition, medical health education, etc. It can effectively improve the prognosis of patients with coronary heart disease, heart failure, interventional surgery and surgical rehabilitation period, improve the quality of survival, reduce mortality, reoccurrence rate, etc. It has been adopted by foreign cardiac centers as a routine treatment rehabilitation tool.