Heart and vascular disease - psychosocial consequences of

Problems with your heart? What does that do to you?
Psychosocial consequences of heart and vascular disease

Our heart is not only the motor that provides our body with oxygen-rich blood, it is also the emotional centre of our body. We ascribe various emotions to our heart and this can often be seen in our language expressions: it broke my heart; a man after my own heart; it comes from the bottom of my heart and she has a heart of gold. A disturbance in our heart, therefore, does not only often have medical consequences, but can also have emotional, personal or social consequences and can even affect our relationships.

Psychological consequences  
You may have the feeling that you are out of balance or have lost your equilibrium and this can be expressed in, for example, the following ways:  

• Fear of physical exertion, including sexual exertion;
• Fear of being alone;
• Fear at night or restless sleep;
• ‘Feeling’ your heart 24 hours/day;
• Mood swings;
• Feeling listless, irritable and emotional;
• Problems with forgetfulness and poor concentration;
• Lack of self-confidence or feeling dependent on others.

Vicious circle
It is understandable that people are concerned or even fearful of a reoccurrence of the heart symptoms. Because of what you have experienced, you have become much more alert and it is often difficult to differentiate among the various feelings/complaints. Feelings of anxiety may, in themselves, cause symptoms that resemble heart symptoms, such as tightness in the chest, shortness of breath, heart palpitations and feelings of anxiety, perspiration and nervousness. These symptoms and feelings are a normal reaction of the body to tension but can also cause more fear or anxiety. Thus, a vicious circle is created in which fear and anxiety start to lead a life of their own.

Denial
The opposite of anxiety/fear can also occur. There are also those people who have the tendency to immediately resume their old way of living as if nothing had happened. By doing this, they try to forget what had happened as quickly as possible because the confrontation can be too intense. This can be extremely difficult for the partner/immediate family who, for example, are concerned.

More emotional/irritable
An (acute) heart problem can - as stated above - be extremely gripping. Afterwards, many people experience that they become upset more quickly. One’s resilience is temporarily decreased; it is all quickly too much to handle. This can be difficult for those around you because your reactions may be more intense than they are used to.

Anger
You may have the feeling that your body has let you down and that can make you very angry, sometimes even furious. It feels cruel and unjust that this has happened to you and you ask yourself: why? This anger can be focused on the people around you, the doctors, but also on yourself.

Gloominess/depression
If the anger and disappointment are chiefly focused upon yourself, that can lead to symptoms of depression. If this is the case, you feel gloomy and depressed, you lose your interest in precisely those things you normally enjoy and you are extremely tired. Moreover, your appetite can decrease and your sleeping pattern will be different from what you are used to.

All these reactions and emotions are part of the normal healing process after a heart dysfunction. It is a temporary and transitory process. It is all about slowly finding a new equilibrium during which it may be necessary to adjust or change your behavioural patterns.

Social consequences

Environment
While you are feeling what you are feeling, what is wrong with you is often invisible to those around you. On the outside, you often look good again, but on the inside, you may still be off balance.  In the beginning, there is a great deal of attention, but after a time that attention will decrease and you may get the feeling everyone feels that it is time for it all to be over. But, that is not always necessarily the case. The body may be healed, but you must still process what has happened to you and this sometimes takes longer than you want it to.

Partners and immediate family
Partners have often also gone through a difficult time and their own insecurity can turn into over-anxiousness. It remains important to communicate openly and honestly with each other, so that over-anxiousness can be more quickly identified and discussed.
Ultimately, it is important that you become equal partners again. Be sure to resume your own activities, as before.  As a patient, you are often the centre of attention. Meanwhile, the partner can have the feeling that he/she must do everything alone.  
Sometimes, he/she feels a bit cheated and, at the same time, is ashamed of these feelings. It is therefore also important to give your partner/immediate family the opportunity to talk about their possible fears and insecurities and about their experiences surrounding the heart incident.

Single
If you live alone, it is possible that a good listener and help cannot be taken for granted. Family and friends will probably be fairly willing to help, but the initiative will often have to come from you.
When necessary, do not hesitate to call friends and acquaintances yourself, because not everyone knows that practical help is necessary or knows how to act towards someone who has had a heart dysfunction.

Sexuality
If you can walk up two flights of stairs without becoming extremely short of breath, there is then, in general, no problem at all with sexual exertion.
Some drugs (diuretics, beta-blockers) may influence sexuality. Do not hesitate to discuss sexuality problems with your doctor; it is sometimes possible to adjust the medication. In particular, however, discuss your feelings -- and sexual feelings and possibilities -- with your partner.

Rehabilitation
After a heart condition, you may be asking yourself what you may still do and what you must stop doing.
May I still do sports? What will happen if I get agitated in traffic? Must I adjust my diet? Cardiac rehabilitation promotes your recovery and physical condition, answers practical questions and, by doing this, helps you pick up the thread of your life again. You may obtain a referral from your specialist, family doctor or company doctor.

More information
Additional information can be found in the brochures of the Nederlandse Hartstichting [Netherlands Heart Foundation]. They also have a dedicated free information number: 0800 - 3000 300 (Mondays - Fridays 9.00 am - 5.00 pm).

De Hart & Vaatgroep [The Heart & Vascular Group] is a patient organisation by and for people with heart and vascular disease. Both regionally and nationally, De Hart&Vaatgroep is focused on the provision of information, contact among fellow patients, lifestyle management and the collective protection of interests. Tel: 030 - 6594657 or www.hartenvaatgroep.nl.

You can also find a great deal of information on the internet via: www.hart.pagina.nl
For cardiac rehabilitation, you may contact the Bronovo Regional Cardiac Rehabilitation Centre,Tel: 070 - 3124465.

We wish you a good and speedy recovery.

Medical Social Work Bronovo
Regional Cardiac Rehabilitation Centre

Edition: April 2010/77