Coping
Coping with a Cardiac Condition can be very challenging
Go to the above links for some useful information.
Below some information from the website: www.cardiomyopathy.org
Psychological adjustments in cardiomyopathy
Finding out that you have a diagnosis of cardiomyopathy can be distressing, but most people come to terms with the diagnosis. We all have different ways of adjusting and there is no right or wrong way. In the early stages it is normal to feel shock, anger and disbelief. Stress, fear and anxiety can sometimes help us to re-examine and to change our lifestyles, and the idea that all stress is bad for us is simply nonsense. Nonetheless, when emotions like this persist for months on end, or begin to overwhelm us, they can merge into treatable medical diagnoses such as anxiety and depression.
A study at St. George’s Hospital in London found that two fifths of patients with cardiomyopathy had a current ‘anxiety disorder’ and one fifth had ‘depression’. This was more than just distress, sadness or grief. Many patients also experienced problems with physical intimacy, but had difficulty in discussing those problems with health care professionals.
What is anxiety?
Anxiety combines physical and psychological symptoms. You may feel worried all the time, constantly fatigued and unable to concentrate, irritable or with poor sleep. Anxious people experience bodily symptoms such as palpitations, sweating, rapid shallow breathing, dizziness, fainting, muscular tension, indigestion and diarrhoea. All of these symptoms may be wrongly interpreted as symptoms of cardiomyopathy, and worrying about this can make the emotions spiral out of control. Sufferers may avoid talking about their feelings for fear that other people may think that they are ‘mad’. Irritability can cause conflict with those who love you, and people with severe chronic anxiety often hold the world at arms length.
What to do about anxiety?
Talking to someone is the first stage in finding a solution. Friends and relatives can be ideal, but sometimes it is easier to talk to a stranger. Talking to other people with cardiomyopathy can break down barriers of isolation. Self-help groups can be useful if enough people commit themselves to the group.
Relaxation techniques can help us to control anxiety and attention. Learning to relax is a slow process, like learning to play the piano, and needs to be practiced regularly, rather than to be relied on in a crisis. Health care professionals can teach relaxation techniques, but it is possible to use a variety of books and tapes, (see below). In a few rare cases, the roots of anxiety may be deeper, and may need to be teased apart through psychotherapy, which may take weeks or months.
Doctors sometimes prescribe medication for anxiety, and this can be helpful in some cases. Sleeping tablets, tranquillizers, benzodiazepines are highly effective but can also become addictive after only four weeks of regular use. As a short-term measure they can be very useful but should not be used for longerterm treatment. Sometimes anti-depressants can be useful for chronic anxiety.
What is depression?
Feeling fed up or miserable is normal, and feelings like this usually don’t last for long or interfere significantly with our lives. We say that someone has ‘clinical depression’ when these feelings persist and severely interfere with our lives.
Feelings of clinical depression can last for months and affect a range of physical and psychological functions, including sleep disturbance, loss of appetite and frequent thoughts that life is not worth living. Depression comes on gradually and we do not recognize how depressed we are. Sometimes we pay more attention to our physical symptoms than our psychological state. Physical symptoms such as chest pain can actually be signs of a depressive episode.
Depression is different to the normal grief than one would expect in being told you have the diagnosis of cardiomyopathy, in so far as grief passes through stages of acceptance and reconciliation, whereas depression hangs over us for months at a time.
What to do about depression?
A regular active routine can be effective for mild depression. Having cardiomyopathy restricts vigorous exercise and you should consult with your doctor if you are uncertain about activity, but that shouldn’t stop you being active.
People with depression may stop looking after their body, losing weight and ignoring essential nutrients. Many people with depression have difficulty sleeping. Sleep disturbance does not kill you, so try not to worry too much about sleep difficulties.
Nonetheless, establishing regular habits of eating and sleeping can help your mood. Alcohol seems to make us happy but is actually a depressant. Studies suggest a small minority of people with cardiomyopathy are driven to drink, giving transient relief of symptoms, but this will only make things worse.
When depression starts to significantly affect your hobbies, social relations and occupation, when you start to believe that life is not worth living, or when the feelings are persisting for a long time, then is the time to seek help, and you should approach your family doctor. Professional help is often necessary, usually treated by family doctors who may recommend some sort of talking treatment, anti-depressants tablets or a combination of the two. Talking to a trained counsellor or therapist can be easier than talking to people you know. There are many different forms of psychotherapy. Cognitive therapy looks at the structure of your thoughts, and helps to overcome the automatic thoughts at the root of depression. Dynamic and inter-personal therapies can help look at relations with others. Talking therapies take time to work, and you may need to see a counsellor for many sessions over several weeks before you gradually experience an improvement.
Severe or chronic depression may benefit from a course of anti-depressants. Having cardiomyopathy may limit the choice of anti-depressant for your doctor, but will not stop you getting a prescription if you need one. It can take several weeks to experience beneficial effects from anti-depressants. Anti-depressants act on chemical substances in the brain called neuro-transmitters. This is not to suggest that depression is nothing but chemical event, but sometimes modest improvements in brain chemistry can have substantial benefits for overall functioning. A minority of patients may need more specialist help from a psychiatrist or member of a mental health team.
Specific help for cardiomyopathy
All chronic medical conditions like cardiomyopathy require the patient to become the expert, and many patients will know more about the condition than some doctors. This applies as much to emotional as to physical sequelae. Chatting to other people with the diagnosis can be invaluable. Nurses and doctors working in dedicated clinics have a tremendous range of expertise and understanding.
Accessing more specialist psychological treatments can be difficult but, if you need help then you should ask for it. Most people come to terms with cardiomyopathy, but some people will require extra assistance. If one of those people is you, you should ask your family doctor for more
Further information
Books support.
Anxiety and Depression by Robert Priest (McDonald and Co.)
Don't Panic: a guide to overcoming panic attacks by Sue Breton (McDonald and Co.)
Living with Fear by Isaac Marks (McGraw Hill)
Peace from Nervous Suffering by Claire Weekes (Angus and Robertson)
Self-Help for your Nerves by Claire Weekes (Angus and Robertson)
Tapes
Control Your Tension, Lifeskills, Bowman House, 6 Billetfield, Taunton, Somerset TA1 3NN. Tel: 01823 451 771
The Mitchell Method of Relaxation Laura Mitchell, 8 Gainsborough Gardens, London NW3 1BJ.