Dealing with Depression, Anxiety and Panic Attacks after a Heart Attack

The recovery process after a heart attack varies from person to person. How people deal with the "ups and downs" during this period is not the same for everyone.

For me, I found rediscovering an old hobby, photography, went a long way to helping me deal with depression, anxiety and panic attacks. I talk about this when I give talks at our local cardiac rehab group which is what I did just a couple of days ago at my first presentation for 2016.

Depression and anxiety after a heart attack is not uncommon and but talking about it is something people are usually reluctant to do. My raising these issues from the standpoint of someone who has been through the process usually is the stepping-stone for some present to open up and talk about what is bothering them as they start their road to recovery after their heart event.

I usually start the discussion off along the lines that it was rediscovering photography that helped me deal with many months of depression and anxiety after my heart attack and bypass surgery in 2007. I explain that at the time of my heart attack my wife was involved in looking after injured wildlife and that now, having free time on my hands, I soon started helping my wife. I go on to explain that where we live we have lots of wildlife that visit us daily and that picking up a camera and starting to take photos soon became a daily activity.

A few years ago I created a Facebook page where I could feature some of my photos where I continue to feature photos of various wildlife that visit us where we live in the Gold Coast hinterland in Queensland, Australia - https://www.facebook.com/Wildlifeinnerang/

In my talks I suggest to people that their recovery period is an opportunity for them to rediscover or pick up a hobby that maybe they have not thought about for years be it knitting, gardening, cooking, tennis, golf, swimming, etc.

Having introduced the topic at last Thursday’s talk, two people present told how cooking has become an important part of their lives and another person talked about getting involved in designing.

In my talk on Thursday I added that in addition to my photography which I am still passionately involved in, a second activity I undertake on a daily basis is walking (exercise). Not only does it help me with my diabetes (and my heart) whenever I feel “down” or an episode of depression coming, I explained to the group that simply going for a walk usually helps me deal with the issue.

Presenting at Cardiac Rehab

Honoured to have been asked by our local cardiac rehab unit to once again be part of their education programme in 2016. First session this year is in two days time.

In 2008, a year after my heart attack I was invited to give a “one-off” talk at the cardiac rehab unit on the Gold Coast. This happened not long after I had given a number of interviews for TV and our local newspaper in which I was asked about my heart event and my experience dealing with 29 cardioversions/resuscitations and having three stents for a 100% blockage to the right coronary artery and then five days later, a triple bypass for blockages on the left side of the heart.

Being asked to present to people doing cardiac rehab about how I coped with my heart attack and subsequent depression, anxiety and panic attacks was something I embraced without hesitation and was something that I can now look back on that helped me deal with these issues – to say this was cathartic would be an understatement.

After this “one-off” talk I was asked to become a “regular” part of the cardiac rehab programme and was more than happy to accept this request - this was in late 2008.

Now, going on eight years after my first talk, I will be continuing with my presentations and although the format has changed over the years, my experiences have not and sharing these with those present at each session is something I thoroughly enjoy – it is indeed gratifying seeing people in front of you nodding in agreement when you make a point or comment on an experience you have been through and it tells you that you are “connecting” and that what you are talking about is relevant.

Of particular interest is when I talk about my diabetes and my need to be aware of this and the impact of this insidious disease on the heart – you can see straight away who amongst those present also deals with diabetes by their reactions to what I am saying.

Another topic I cover is memory loss and forgetfulness, two issues I had to deal with and issues that are often brought up during one of my talks.

Probably the most significant thing about my being part of the rehab education programme is that I have had a heart attack and bypass surgery and have actually been through the cardiac rehab programme itself. Unlike the staff (except for one person I am aware of) I am the only presenter who can speak from first-hand experience and I truly believe that this is so very important when offering a rehab programme.

So as 2016 begins I look forward to giving my first talk in two day’s .

Memory Problems and Heart Disease: Postperfusion Syndrome and Vascular Dementia

Continuing on with a topic I ended 2015 on, Postperfusion “Pumphead” syndrome, memory loss and cognitive issues after open heart surgery.

I recently came across a blog on the internet called “Rehabilitate the Heart” which I felt is very relevant to those of us who have had open heart surgery and more importantly, an article that has relevance to those close to us including spouses, partners and children. 

And given this question of memory loss comes up so often in social media "heart" groups such as Facebook and in cardiac rehab programmes I feel another post on this topic is more than appropriate.

This blog not only continues on with the discussion regarding postperfusion syndrome but also introduces the question of Vascular Dementia.

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"Working in Cardiac Rehabilitation it wasn’t uncommon for a spouse or significant other to come in with the patient on the first day or early on in their rehabilitation and voice concern about the patients memory. It is common during the first three months after open heart surgery to be forgetful, to not remember little things, to be frustrated easily. However, within three months these issues should improve. There are a number of people however who have a steady decline in what we call cognitive health or  show cognitive impairment. They begin to display progress symptoms of dementia. This is very real and it is very scary, for both the patient and the caregiver.

Two common reasons for the mental decline are Pump Head and Vascular Dementia

Postperfusion syndrome, also known as “pumphead” is an impairment of cognitive symptoms attributed to Open Heart Surgery. Symptoms of postperfusion syndrome are subtle and include defects associated with attention, concentration, short term memory, fine motor function, and speed of mental and motor responses. Studies have shown a high incidence of these issues soon after surgery, but the deficits are often short lived with no permanent damage and last only a few months. It is when the symptoms persist beyond the first few months are concerning.

The symptoms of pumphead include:

·        difficulty in concentrating

·        increased depression

·        short term memory deficit

·        slower speed of mental and motor responses

“Pumphead”  refers to the state in which patients seem to linger after being hooked up to a heart-lung machine for open-heart or valve surgery.  The clinical term for pumphead is cognitive impairment after coronary artery bypass grafting (CABG). Other symptoms include poor recall, social difficulties and personality changes. Pumphead is when after an initial recovery of mental capabilities in the first few months, the condition often worsens later and persists for years.

Cognitive training may improve memory and reasoning in patients after CABG  

Thus the new area of rehabilitation, cognitive rehabilitation, such as after an acute injury to the brain like a closed head injury or a stroke.

"A new study results confirm that older adults who undergo CABG experience postoperative cognitive decline but show that cognitive training improves memory and attention, suggesting that this training can be a useful rehabilitation tool.

Cognitive training is a “burgeoning business,” much of which involves computer-based puzzles and brain games. While there’s a lot of suggestive evidence of an association between mental stimulation and lower risk for dementia, “we need to do more science around it to find out what works and what doesn’t work,”

http://www.theheart.org/article/1454099.do 

Is it Pump Head or Vascular Dementia?

Inadequate blood flow can damage and eventually kill cells anywhere in the body. The brain has one of the body’s richest networks of blood vessels and is especially vulnerable.

In vascular dementia, changes in thinking skills sometimes occur suddenly following strokes that block major brain blood vessels. Thinking problems also may begin as mild changes that worsen gradually as a result of multiple minor strokes or other conditions that affect smaller blood vessels, leading to cumulative damage. A growing number of experts prefer the term “vascular cognitive impairment (VCI)” to “vascular dementia” because they feel it better expresses the concept that vascular thinking changes can range from mild to severe.

Vascular brain changes often coexist with changes linked to other types of dementia, including Alzheimer’s disease."

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Use this link to read the entire blog: https://rehabilitateyourheart.wordpress.com/2012/10/08/memory-problems-with-heart-disease-pump-head-and-vascular-dementia/

Claustrophobia and Bypass Surgery

One of the first things I noticed a few months after my heart attack and triple bypass surgery in July, 2007 was a problem I had going into elevators and confined spaces. It first happened a couple of months after my surgery when my wife and I travelled to Twin Towns club to see a show and we had to take the elevator from the ground floor to the sixth floor where the auditorium was located.

  

Now this was not the first time we had been to this club to see a show and certainly was not the first time we had taken the crowded elevator up to the floor where the show was taking place. However, it most definitely was the first time, as we were standing at the back of the full elevator, that a feeling of “dread” consumed me and I felt like screaming and collapsing and could feel my heart racing.

My wife could see what was happening, it was that obvious I guess.

In short, I felt like I was having a panic attack and it wasn’t nice. In fact this was the first of what was to be a series of such attacks any time I went into an elevator or found myself in a confined space like in the back of a coffee shop or even sitting between two people in the back seat of a car.

That feeling also reared its ugly head during the show itself, a Wickety Wak show from memory - we were seated in the middle of a row in a full house and that feeling of being surrounded and "cramped in" was both new and difficult to cope with.

As I soon found out, this feeling of claustrophobia/panic attack/anxiety became the norm and occurred when we went to the movies or to see a show at any venue. I learnt very quickly when booking tickets for a show to book aisle seats.

And this feeling of an impending anxiety attack still happens today when we go to the movies or to see a show eight years later!

I can distinctly remember on one occasion when I took the train from where I live on the Gold Coast up to Brisbane how I had to go through “mind control” and deep breathing exercises to overcome that terrible feeling of a panic attack coming on whilst sitting in the “confined” space of a train car.

When this first happened I did some research and asked around and even asked other people who had gone through bypass surgery if they had had similar experiences and asked them if they understood what I was talking about.

To be truthful, not everyone knew what I was referring to but there were some who did which, I guess, made me feel like I was not crazy and not the only one dealing with these issues.

I also mentioned this to my cardiologist and he confirmed that this was not knew for what people like me had been through: heart attack, multiple cardioversions and of course open-heart surgery/triple bypass.

Knowing this was helpful, dealing with it was the challenge and as I said above, I had to develop techniques to cope which included deep breathing and “concentration” exercises to help me take my mind off the problem.

In early 2011 following heart related issues my cardiologist ordered me to have a CT angiogram and I can clearly remember today, 4+ years later how I just about freaked out when they l lay me down and I started to go through the tunnel, twice they had to pull me out before I could complete the test.

And a year later in 2012 I had a similar bad experience when I needed a CT scan for lower back/spine issues to determine what was causing me severe lower back pain. This happened again earlier this year when I again needed a SPECT CT scan on my back.

My biggest challenge came three years later in October, 2010 when I had to fly interstate. The thought of this scared me and even though it was enough to just about bring on a panic attack. I took the flight. I remember I really had trouble coping and whilst it may not have been obvious to those around me on the plane, I know inside myself I was anxious and really struggling to keep it together.

Over time I thought, hoped, this would get better and I guess it did, however, three years later in January, 2013 I had to fly interstate for one of my children’s weddings. The whole process began again and the “fear of flying” became real. The flight was twice as long as the one a few years earlier and I was fearful I was going to have issues again.

This time I planned ahead. I made sure I had aisle seats so that I would not have that “cramped in” feeling sitting against the window if the flight was full. I also decided that this time I would take a valium to help calm me down. Doing this definitely helped.

Now, a few years later I am preparing for another interstate flight and part of me is dreading this. Sure, things have improved a lot since my surgery in 2007 but that fear is still there. I have booked aisle seats so this is taken care of and I will no doubt take a Valium before the flights and I am sure everything will be fine, however, best to be prepared as I was taught in the Boy Scouts.

Dealing with the after effects of a heart attack and bypass surgery is one thing, coping with these in addition to dealing with additional medical issues including diabetes, thyroid and respiratory conditions can most certainly make life challenging.

This is a link to an interesting article that deals with this question of Claustrophobia and Bypass Surgery: http://www.canada.com/story.html?id=b9cffbea-8c7f-4f9e-a2eb-0614bfd42b4d

Claustrophobia link to heart bypass: study

Canadian researchers have uncovered what seems like a bizarre side effect of a common operation, finding many heart-bypass patients experience severe claustrophobia after their surgery.

Pump Head - Cognitive Impairment After Bypass Surgery

A study from Duke University, published in the New England Journal of Medicine in February, 2001, confirms what many doctors have suspected, but have been reluctant to discuss with their patients: A substantial proportion of patients after coronary artery bypass surgery experience measurable impairment in their mental capabilities.

In the surgeons’ locker room, this phenomenon (not publicized for obvious reasons) has been referred to as "pump head."

In the Duke study, 261 patients having bypass surgery were tested for their cognitive capacity (i.e. mental ability) at four different times: before surgery, six weeks, six months, and five years after bypass surgery.

Patients were deemed to have significant impairment if they had a 20% decrease in test scores.

This study had three major findings

·        * Cognitive impairment does indeed occur after bypass surgery. This study should move the existence of this phenomenon from the realm of locker room speculation to the realm of fact.

·        * The incidence of cognitive impairment was greater than most doctors would have predicted. In this study, 42% of patients had at least a 20% drop in test scores after surgery.

·        * The impairment was not temporary, as many doctors have claimed (or at least hoped).

You can read more about this study using this link: http://heartdisease.about.com/cs/bypasssurgery/a/pumphead.htm

Postperfusion syndrome, also known as "pumphead"

"Postperfusion syndrome, also known as "pumphead", is a constellation of neurocognitive impairments attributed to cardiopulmonary bypass during cardiac surgery. Symptoms of postperfusion syndrome are subtle and include defects associated with attention, concentration, short term memory, fine motor function, and speed of mental and motor responses. Studies have shown a high incidence of neurocognitive deficit soon after surgery, but the deficits are often transient with no permanent neurological impairment." http://en.wikipedia.org/wiki/Postperfusion_syndrome

This is not something to be dismissed lightly and many who have had bypass surgery comment on issues such as memory loss after surgery. Sometimes talking to others who have dealt with this problem is helpful.

Postperfusion Syndrome (pumphead) Facebook groups:

These groups may help people who have suffered memory loss after cardiac surgery and/or issues with fine motor skills and speed of mental and motor responses. Use these links to find out more about these group:

https://www.facebook.com/groups/277112179141875/
https://www.facebook.com/groups/1490829674283544/

Heart Disease and Stress Tests

A stress test can be used to test for heart disease. Stress tests are tests performed by a doctor and/or trained technician to determine the amount of stress that your heart can manage before developing either an abnormal rhythm or evidence of ischemia (not enough blood flow to the heart muscle). The most commonly performed stress test is the exercise stress test.

What Is an Exercise Stress Test?

The exercise stress test -- also called a stress test, exercise electrocardiogram, treadmill test, graded exercise test, or stress ECG -- is used to provide information about how the heart responds to exertion. It usually involves walking on a treadmill or pedaling a stationary bike at increasing levels of difficulty, while your electrocardiogram, heart rate, and blood pressure are monitored.

Why Do I Need a Stress Test?

Your doctor uses the stress test to:

• Determine if there is adequate blood flow to your heart during increasing levels of activity
• Evaluate the effectiveness of your heart medications to control angina and ischemia
• Determine the likelihood of having coronary heart disease and the need for further evaluation
• Check the effectiveness of procedures done to improve blood flow within the heart vessels in people with coronary heart disease
• Identify abnormal heart rhythms
• Assess the function of heart valves if they are not functioning properly
• Help you develop a safe exercise program

What Are the Types of Stress Tests?

There are many different types of stress tests, including:

• Treadmill stress test: As long as you can walk and have a normal ECG, this is normally the first stress test performed. You walk on a treadmill while being monitored to see how far you walk and if you develop chest pain or changes in your ECG that suggest that your heart is not getting enough blood.

• Dobutamine or Adenosine Stress Test: This test is used in people who are unable to exercise. A drug is given to make the heart respond as if the person were exercising. This way the doctor can still determine how the heart responds to stress, but no exercise is required.
• Stress echocardiogram: An echocardiogram (often called "echo") is a graphic outline of the heart's movement. A stress echo can accurately visualize the motion of the heart's walls and pumping action when the heart is stressed; it may reveal a lack of blood flow that isn't always apparent on other heart tests.
• Nuclear stress test: This test helps to determine which parts of the heart are healthy and function normally and which are not. A small amount of radioactive substance is injected into the patient. Then the doctor uses a special camera to identify the rays emitted from the substance within the body; this produces clear pictures of the heart tissue on a monitor. These pictures are done both at rest and after exercise. Using this technique, areas of the heart that have a decreased blood supply can be detected.

Preparation for these types of stress tests will vary from preparation for the exercise stress test. Ask your doctor about any specific instructions.

Learn more about stress tests and different forms of tests that are used using this link: http://www.webmd.com/heart-disease/guide/stress-test