Why she was still uncomfortable after the pacemaker installation
A 70-year-old female patient, who had been in good health, was still teaching after retirement. She went to the hospital because of dizziness and shortness of breath for two weeks. An electrocardiogram revealed that the patient had a slow heartbeat of about 40 beats/min. After the operation, the patient’s dizziness and shortness of breath improved significantly, but three months later, during the consultation, the patient gradually developed heartburn again, often felt tightness in the chest, and sometimes had to sigh heavily to feel comfortable, and even felt suffocated when the chest tightness was severe. The patient suspected a problem with the pacemaker, but repeated program control of the pacemaker showed that the pacemaker was working well, and the memory history of the pacemaker showed that the patient had short bouts of tachycardia, and the patient was informed that the pacemaker was working well, and a beta-blocker was given orally to treat the patient’s tachycardia. However, the patient continued to feel the above mentioned discomfort at several follow-up appointments afterwards, and then wondered if she had myocarditis, but the corresponding tests did not reveal any problem, and the patient was always worried that there was something wrong with her heart or that the pacemaker was not suitable for her. Mao Jialiang, Department of Cardiology, Shanghai Renji Hospital
During the patient’s repeated visits, the doctor gradually noticed that the patient was sometimes more easily agitated, had more nervous facial expressions, spoke more and spoke faster, and considered that these symptoms might be caused by psychological disorders.
When asked about her sleep problems, she said that she could sleep for four or five hours. However, upon further questioning, the patient reported that she often had nightmares and sometimes woke up from them, such as when the Japs entered the village and she was running away (during the anti-Japanese war, the patient lived in the northeast as a child), or when she slowly fell from the sky and had the fear of falling to her death, and she would wake up when she dreamed of being caught by the Japs or falling to the ground, and sometimes she often dreamed that she would step on the stairs and couldn’t find a place to urinate. Sometimes she also dreamed that she would step on the stairs and couldn’t find a place to pee. She is emotionally volatile, thoughtful, easily sad, and can’t help but shed tears when she sees sad episodes on TV (the patient was not like this in the past), easily nervous when things go wrong, and allergic to sound and afraid of noise.
In addition to cardiovascular symptoms such as palpitations and chest tightness, the patient also had other multi-system symptoms: stomach pain and indigestion, neck and back muscle pain, dizziness and headache, numbness and trembling in the hands and feet, sometimes walking with weak legs, throat discomfort, easy fatigue and blurred vision.
On a psychological scale, the score was 45 for anxiety and 32 for depression. The patient was considered to have symptoms of anxiety and depression and was given anti-anxiety and depression medication. After one and a half months of treatment, the above symptoms basically disappeared, and the anxiety score decreased to 25 and the depression score decreased to 22, and the patient regained his previous health status.
At present, psychological disorder has been one of the main diseases affecting people’s health. One third of the patients attending general hospitals will be troubled by psychological disorder, but unlike other diseases, it is often not recognized and identified, especially when it is together with physical diseases it is more likely to cause underdiagnosis and misdiagnosis, according to statistics, 20% of patients with pacemakers will have different degrees of psychological disorder. These patients repeatedly go to the doctor and often undergo a large number of tests and various treatments, but the results are not satisfactory, but add to the patients’ economic and mental burden. Contrary to our previous understanding, psychological disorders can not only have emotional problems, but also physical discomfort, just like the patient in the previous case. Although it is not easy to identify psychological disorders clinically, when we meet patients with certain symptoms that cannot be fully explained by physical illness, we may consider the patient’s disease condition from the perspective of psychological disorders, which may better help patients to relieve their pain.
Dr. Jia-Liang Mao, MD, Chief Physician, Department of Cardiology, Renji Hospital, Shanghai Jiaotong University School of Medicine
Clinic hours: Tuesday, Wednesday, 1:30 pm
Specialties: pacemaker treatment, cardiac neurology diagnosis and treatment