There are 3 types of relationship between bipolar heart disease and heart disease
The relationship between psychological heart disease and heart disease is divided into 3 broad categories.
First, psychological heart disease can exist independently. In other words, the patient does not have a real heart disease, but mainly mental, emotional and spiritual problems cause heart disease-like symptoms, and once the patient has an attack, it is like a heart attack.
Secondly, psychological heart disease exists in combination with heart disease. Due to personality, genetic or environmental reasons, the patient is under very strong bad emotions and mental stress. Gradually, his heart becomes damaged and organic heart disease, such as coronary heart disease and arrhythmia, occurs. This type of patient needs treatment for heart disease, but at the same time, he also has psychological problems. In general, such patients tend to have psychological problems in the first place and heart problems in the second.
In the third case, the heart disease, as a stressful blow, causes psychological changes in the patient. For example, there are many patients with coronary artery disease who feel uncomfortable after stenting or bypass surgery, although the revascularization is successful and the ECG results indicate good blood supply to the heart. The patient will say, “After the surgery, the doctors said it was fine, but for some reason, I felt the symptoms were getting worse.” This is often a case of heart disease first and then a psychological problem.
In short, there is a very close relationship between psychological problems and heart disease, both in terms of symptoms and diagnosis. That’s why it’s usually named after bipolar heart disease.
Why do psychological and emotional problems cause symptoms of the heart? What is the approximate mechanism?
There is indeed an inextricable link between psychological and emotional problems and heart disease, and there is a very complex pathophysiological mechanism behind it. Simply put, when a person is anxious and anxious, the excitability of the nervous system increases and the body releases many neurotransmitters such as adrenaline and norepinephrine. These neurotransmitters cause blood vessels to constrict, and the corresponding local tissues of the heart may become ischemic or react in certain ways, causing some symptoms similar to heart disease.
Why do many patients have heart tests that do not reveal any problems?
For heart problems caused by anxiety and stress, it is really difficult to detect them if they are not at the time of onset.
Usually, for patients with heart disease symptoms, we first perform some routine screening tests, such as electrocardiogram, ultrasound, and imaging, to find out whether there are organic problems in the heart. In addition, we also perform appropriate stress measurements, such as mood scales, to reflect whether the patient has emotional and psychological problems and whether these problems are associated with corresponding myocardial ischemic events.
What is the current prevalence of psychological heart disease?
The prevalence of psychological heart disease should be high, but as far as we know, a significant proportion of patients are overlooked. The modern medical model is to look for organic heart disease, such as through imaging to see if the patient’s blood vessels are blocked or not, how much they are blocked, and if the myocardium is ischemic. Certain patients with psychological heart disease often have large blood vessels that may not see lesions, or the lesions found on examination are not enough to explain his own symptoms and may be overlooked.
There are no clear data on the prevalence of psychological heart disease. However, we have observed that about 1/3 of all patients seen in outpatient clinics have psycho-emotional cardiac problems, but they have no detectable organic heart disease.
However, there are also very many heart patients who have developed psycho-emotional problems after various tests and invasive treatments. Because, there are more and more invasive tests of all kinds, for patients, these tests or treatments are also a mental stimulus. If this stress is not relieved, it can trigger a series of cardiac symptoms or aggravate the symptoms of the original heart disease. According to existing surveys, roughly 50-60% of heart disease patients will have a combination of psychological problems, which means they develop bipolar heart disease.
Who is at risk of developing psychological heart disease? Is there a high risk group?
First of all, women during menopause are at high risk. Generally, around menopause, women’s hormone levels drop, which can lead to disturbances in the body’s internal environment and may bring about a range of psychological and cardiac symptoms. However, some people have a bad transition at this time and slowly and literally go from heart disease to real heart disease. Because of the disturbed internal environment, the hormonal damage to the entire blood vessels is potentially irreversible.
In fact, not only women in menopause, but also men in menopause face a similar situation. men in their 50s often feel overwhelmed by the decline in hormone levels. However, since the stress of work may still be present but not properly adjusted, gradually, various heart problems may develop.
In addition, certain highly stressed occupational groups are also prone to psychological heart disease. Long-term engagement in high-risk operations will inevitably lead to psychological tension, and over time it may evolve into psychological heart disease.
In addition, patients with depression and anxiety who have mental problems themselves are also very prone to psychological heart disease. People with depression tend to have insufficient pentothal in their bodies, and this condition triggers exactly the same damage to blood vessels. Secondly, people suffering from depression tend to be inactive and have no energy for anything. However, years of sedentary and sedentary, resulting in poor blood flow, can easily trigger heart disease. Therefore, many people with depression die in heart attack events.
The occurrence of psychological heart disease is also associated with a specific personality. Some people tend to be anxious, sensitive, and vulnerable, or are introverted and under a lot of stress without venting it. In these people, the neuroendocrine system in the body is easily activated and secretes more epinephrine and norepinephrine, which triggers vasoconstriction and can easily lead to damage of the coronary vessels.
How to confirm the diagnosis of a patient with psychological heart disease?
Mainly we have to do two things: first, to complete the screening of organic diseases of heart disease; second, to complete the corresponding psycho-psychological and even emotional stress assessment. Only then can we determine whether there is a problem with the patient’s heart, psychology, and whether there is a correlation between the two.
Generally speaking, when patients come to the clinic, they will first undergo electrocardiogram and cardiac ultrasound; after that, they may have an ambulatory electrocardiogram to see if there is myocardial ischemia at night or during exercise; they may also have an exercise plate test to find out at what level of exercise the patient has myocardial ischemia; if the exercise plate test is positive, they may also have a coronary CT or angiography to see if there is a blood vessel There is no blockage.
When this series of tests is done, the doctor will have a general grasp of the patient’s heart condition. After that, the doctor will assess the patient’s mental and psychological problems, such as asking the patient, “Has anything special happened recently,” “Is there a lot of stress at work,” “Do you have a habit of staying up late? ” “How is the state of life”, etc.
The doctor will initially understand the patient’s regular status, and after that, delve deeper into his mental stress problem. Next, the patient may need to do some assessments, such as those for depression, anxiety and other mental problems. Through these methods, the doctor can basically determine the patient’s mental, psychological or emotional state.
Are all patients with psychological heart disease accompanied by emotional problems such as anxiety and insomnia?
Most do, but some may have typical psychological problems, some may not, some have obvious symptoms, and some have insidious symptoms.
We meet a lot of patients who seem very sunny and cheerful, and I ask them, “Have you ever been in a bad mood, are you unhappy?” They say, “No, I’m happy all day long.” In fact, as we gradually screen, we find that these patients have insidious depression, also called masked depression, where they look happy while inside they are sad, only the sadness doesn’t show up as easily. This requires careful identification and diagnosis by the doctor.
Psychological heart disease must be treated
It is a misconception that psychological heart disease must be treated. Many patients tell me, “Doctor, I don’t want to take medicine or have tests, I’ll just go back and try to enlighten myself.” In reality, however, in many cases it is not possible. This is because there is a corresponding material basis for psychological heart disease, such as the neurohormonal disorders and even deprivations talked about above. If these problems are not improved, the patient’s state may still not be relieved.
At present, what are the main treatments for psychological heart disease?
Treatment is divided into four main areas, and we always emphasize that pharmacological treatment comes last. First, psychological support treatment, for example, we encourage patients to spend more time with their families and good friends to find an emotional outlet that facilitates their own recovery.
Secondly, we suggest patients to change their lifestyle, such as insisting on 40 minutes of physical exercise every day (jogging, skipping rope, swimming, etc. are available), so that the blood circulation in the body is accelerated and the metabolism is promoted, which is conducive to the recovery of benign hormones.
Third, dietary treatment, patients are recommended to adopt a balanced, diversified and moderate diet to supplement various nutrients, which is conducive to improving the emotional state of patients.
Fourth, drug treatment. We will use some neuromodulatory drugs, as well as anti-anxiety and anti-depressant drugs, and certain Chinese medicines to help patients to get out of depression and anxiety in time.
Generally speaking, what kinds of drugs are available?
In terms of pharmacological classification, we may use Chinese or Western medicine. Some herbs of the blood activating and aromatic opening class can be used to soothe the mood and treat bipolar disorder. The most commonly used western drugs are pentraxin reuptake inhibitors, which can normalize the level of pentraxin in the patient’s body and help improve the patient’s emotional state.
In addition, there are dual-channel drugs that can improve both pentraxin and norepinephrine levels. For small vessel dysfunction in the heart, we apply drugs to improve the microcirculation of the heart, thus improving the patient’s heart condition.
How does the medication work? How long does it usually take for the patient’s symptoms to be relieved?
Generally speaking, after two weeks of treatment with a combination of Chinese and Western medicine, the patient’s condition will improve significantly; after one month, the patient will basically be in a stable stage. However, during the whole treatment process, patients will have some slight repetition and fluctuation, and the patient’s symptoms will not decline linearly, but gradually like a spiral shape.
How long does general medication take? Do I need to take medication for life?
The duration of treatment depends on the patient, usually as little as 2-3 months or as much as 7-8 months, and in some cases it may take longer.
The vast majority of patients do not require lifelong treatment. We always believe that medications are a “crutch” to help patients regain their quality of life. As the body heals, the patient’s own ability to recover gradually increases, and the patient can gradually throw away the medication as a crutch. We are against the idea that patients should always rely on drugs, even for the rest of their lives.