Psychiatric symptoms, type A behavior, and arrhythmias following coronary bypass

Anxiety and coronary heart disease: a synthesis of epidemiological, psychological, and experimental evidence

The purpose of this review is to examine the epidemiological, psychological, and experimental evidence for an association between anxiety and coronary heart disease (CHD). Papers published during the years 1980-1996 on anxiety and CHD and relevant publications from earlier years were selected for this review. Epidemiologic evidence suggests that anxiety may be a risk factor for the development of CHD. Chronic anxiety may increase the risk of CHD by: (a) influencing health behaviors (e.g. smoking); (b) promoting atherogenesis (e.g. via increased risk of hypertension); and (c) triggering fatal coronary events, either through arrhythmia, plaque rupture, coronary vasospasm, or thrombosis. Electrophysiologic evidence is particularly compelling: anxiety appears to be associated with abnormal cardiac autonomic control, which may indicate increased risk of fatal ventricular arrhythmias. The strength, consistency, and dose-response gradient of the association between anxiety and CHD, together with the biologic plausibility of the experimental evidence, suggest that anxiety may contribute to risk of CHD and that the relationship warrants further investigation.

Ventricular tachycardia and psychiatric depression in patients with coronary artery disease

PURPOSE

The purpose of this study was to examine the relationship between psychiatric depression and ventricular arrhythmias in patients with coronary artery disease (CAD). The hypothesis was that depressed patients with CAD would have a higher prevalence of ventricular tachycardia (VT) than nondepressed patients with CAD.

PATIENTS AND METHODS

One hundred three patients who were found to have significant CAD by elective diagnostic cardiac catheterization were administered a standardized psychiatric interview and underwent 24-hour Holter monitoring.

RESULTS

Twenty-one patients (20%) met the criteria for either major or minor depression. There were no significant differences between depressed and nondepressed patients with CAD in severity of CAD or in ventricular function. Five (23.8%) of the depressed patients and three (3.7%) of the nondepressed patients exhibited episodes of VT during 24 hours of Holter monitoring (p < 0.008). This difference remained significant even after controlling for relevant covariates.

CONCLUSIONS

We conclude that there is a higher prevalence of VT among patients with CAD and depression than among those CAD patients without depression. This may help to explain the increased risk for cardiac mortality in depressed patients with CAD.

Psychological distress as a predictor of ventricular arrhythmias in a post-myocardial infarction population

A prospective study examining the relationship between psychological distress and ventricular ectopy was conducted with 125 post-myocardial infarction patients equipped with a transtelephonic ECG monitor. Subjects were subsequently grouped according to the occurrence (n = 59) or nonoccurrence (n = 65) of ventricular arrhythmias over a 1-year period. Results indicated a direct relationship between self-reported distress levels and occurrence of ectopic beats. This relationship was unaltered by adjusting simultaneously for known predictors of arrhythmias, including cardiac risk, age, and the prescription of beta-blocker agents. Thus this study represents an initial demonstration in a post-myocardial infarction population that psychosocial factors have prognostic significance for arrhythmias and, presumably, sudden death.

Dyadic social-support for cardiac surgery patients--a Canadian approach

Over the past 15 years there has been a substantial increase in the number of cardiac operations being performed. The role of the lay helper volunteer who has successfully recovered from cardiac surgery, offering support to individuals about to undergo similar surgery, is earning a legitimate place in cardiac rehabilitation. This 'living proof' model of support appears to have a significant buffering effect through increasing the cardiac patients' readiness for cardiac surgery and motivation for cardiac rehabilitation. Most literature focuses on individuals who have suffered a myocardial infarction rather than those who must undergo cardiac surgery. The focus of this article is lay volunteer dyadic social-support for open-heart surgery patients. The authors describe such a program operating in Halifax, Nova Scotia, designed to link volunteers who have successfully recovered from open-heart surgery with those individuals about to undergo similar surgery. Comparisons are also made with parallel support programs in Canada and the United States. Thus far, only crude measurements of the effectiveness of this particular social-support intervention are available. The dyadic social-support that volunteers offer cardiac surgery patients seems to be effective as evidenced by the information discussed in this paper.