Association of Cardiac and Mental Illnesses

Psychiatric disorders are reported up to 50% in heart diseases. The first of these is depression. In daily life, the connection between the heart and emotions has always been the focus of attention and many expressions have entered our daily language. Such as “his heart is in his mouth, he is heartless, his heart is constricted, his heart swells, his heart is lifted…”.

The effects of psychiatric diseases on the heart have been called by various names throughout history. Nervous palpitations, irritable heart, exertion syndrome, cardiac neurosis Especially the type A (ambitious, hardworking) personality structure has been said to be a psychological condition that predisposes to many heart diseases, especially myocardial infarction (heart attack). Today, everyone is aware of the fact that heart diseases are caused by stress and the necessity of living a life away from stress in order to prevent it. The psychiatric component is inevitably important in dealing with cardiac patients or patients with such complaints. As important as understanding patients and making a correct diagnosis is, it is equally necessary to treat the existing psychiatric disease correctly and appropriately.

Myocardial Infarction (Heart Attack)

post heart attack ANXIETY It is the table that appears in the first 24 hours. Upon admission to the coronary intensive care unit, the patient has anxious expectation, perceiving the disease and the negative conditions it brings, and the future as a disaster or threat. The main problem in patients is uncertainty, but 2% of patients experience uncertainty naively; much more experienced as anxiety. When this anxiety is evaluated in terms of psychiatric diagnosis systems, COMMON ANXIETY DISORDERIt reminds of.

Almost half of the patients only report anxiety when questioned, otherwise these patients are skipped. As themes, the patient has fear of sudden death, addiction, loss of status and competence, role changes or loss in sexual function relationships. On the other hand, heart operation, risk of having a new infarction, loss of sexual functions and pain are the main fears of the patient. Considering that the patient already has type A behavioral characteristics, the fear of losing control becomes even more dominant. But on the other hand, denial confronts the clinician as an important problem in the clinical setting. If the patient exhibits a denial that does not interfere with the course of treatment, that is, only keeps the feelings of fear, anxiety or distress associated with the disease from himself, but on the other hand does not affect his compliance with the clinical recommendations, this is exactly the desired situation; acts as a balancing act. But if the patient exhibits insomnia in the clinical setting, removes the serum and gets up to go to the toilet, smokes secretly, or somehow eats the forbidden food instead of the hospital food, then there is a situation that needs to be dealt with. In this case, instead of arguing with the patient, it is appropriate to approach the patient’s effort to keep anxiety away from himself with respect. However, a common practice is to say disaster scenarios to frighten the patient even more in order to break the denial.

After 3 days of hospitalization, denial gradually begins to break down. But on the other hand, the patient confronts the situation thoroughly, perceives the limitations of the disease, and the perception of loss settles in. These feelings lead the patient to depression. In the evaluation of patients with myocardial infarction in the subacute period, approximately 50% DEPRESSIVE SYMPTOMS, 20% MAJOR DEPRESSIONis detected.


Depression is known at the beginning of the causes that increase the risk of death in heart diseases. Depression is the most common psychiatric condition in heart diseases. In the old saying, bodily symptoms are at the forefront. MASKED DEPRESSIONcovers about half of the patients admitted to non-psychiatry clinics.

The risk of major depressive disorder in patients with heart disease is higher than normal. 1.5-4.5 times varies between The incidence of pre-infarction depression in patients with myocardial infarction is 27.5%This rate was determined as 31.5%’ e comes out. On the other hand, the rate of myocardial infarction in depressed patients who are not treated adequately is higher than normal. 6 times can go up. Factors that increase the risk include loneliness, problems in interpersonal relationships, and work stress.

Variable heart rate in depression has been suggested as the leading cause of heart disease and cardiac death in mood disorders. Depression also impairs blood clotting.

Psychosocially, it may worsen the course of heart disease. It prevents the patient from living a life suitable for heart disease (eg, excessive smoking), reduces the patient’s adherence to treatment, prevents him from doing the necessary examinations on time, disrupts his compliance with rehabilitation programs (giving up exercise), and prevents return to functionality.

As a result, depression occurring in heart patients; worsens the prognosis, increases complications and increases the risk of death.


Anxiety is a functional response in the body, which does not have any pathology under normal conditions. Necessary for business success and assertiveness. However, excessive and prolonged anxiety leads to decreased work performance, exhaustion, symptoms of illness (often heart disease) and the use of sedative drugs. Anxiety, which has such an effect, negatively affects both the predisposition to heart patients and the impaired physiology in heart disease.

Just like in depression, heart rate variability decreases in anxiety and blood circulation and rhythm of the heart are negatively affected. Anger and hostility often accompany anxiety in cardiac patients. Anxiety is one of the most important emotional problems to be dealt with in cardiac patients, especially when it occurs with other negative emotions. Anxiety or anxiety that develops especially after myocardial infarction both causes more complications and worsens the course of the disease (in terms of ischemia and arrhythmia).


In clinical practice, panic disorder and myocardial infarction may have the same symptom overlay. In patients with suspected coronary artery disease and therefore planned for further investigation 15% rate of panic disorder. In clinical practice, it is necessary to make the most appropriate treatment as if the patient has panic disorder, but never to exclude coronary heart disease. It should be kept in mind that as they can be confused with each other in the differential diagnosis, they can also be found together.

Cardiac symptoms form a separate cluster in the categorization of panic disorder. Agoraphobia is higher in panic disorder with cardiac symptoms. 89% Palpitations and other cardiac symptoms were detected in . The susceptibility and fears of panic disorder patients to heart diseases lead to a diagnostic confusion.


The fatal nature of heart diseases makes all heart diseases, especially myocardial infarction, a fearful dream for people. Three cardiac symptoms are prominent in psychiatric pictures: Chest pain, palpitations and shortness of breath . These symptoms are directly reminiscent of heart diseases. Chest pain is a symptom found in 12% of all patients presenting for healthcare. However, these patients % 11th In , an organic etiological factor can be distinguished, the rest develops as psychosocial origin. The presence of palpitation in addition to chest pain brings the patient closer to heart disease anxiety.

Feeling like the heart is going to burst, burning in the chest, beating of the heart, pressure in the chest that takes your breath away, and feeling like you are going to die.” are some of the definitions commonly used by patients. Cardiac complaints that occur suddenly, with or without any stress, suddenly disturb the patient. Chest pain was reported to be more significant in terms of location, severity, and extent, and the relief-seeking behavior was more consistent and more typical with no prior stressors. Therefore, the clinician’s likelihood of confusion is substantial.


Somatization disorder is a disorder that starts at a young age with unexplained somatic complaints. These symptoms are actually pain, digestive system, sexual, pseudoneurological However, this combination of symptoms can sometimes directly indicate a heart disease. Sometimes, unexplained somatic complaints may gradually gather around a disease and turn into a belief that the patient is not convinced of. If this table HYPOchondriasisis defined as.

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