Stage B Treatment Options
While stage A CHF is managed with lifestyle changes, the treatment plan for stage B typically includes taking medications regularly. People at this stage should still make the same lifestyle changes as those appropriate for stage A. However, your doctor may also prescribe additional treatments such as:
- Angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, if you arent taking any as part of your stage A treatment plan
- Beta blockers if youve had a heart attack and your EF is 40% or lower, if you arent taking any as part of your stage A treatment plan
- Possible surgery or intervention as a treatment for coronary artery blockage, heart attack, valve disease, or congenital heart disease
When Should I Get Help For Depression
If you feel severely depressed and have symptoms of depression every day for 2 or more weeks, you need treatment to help you cope and recover from depression.You should also see your doctor if you have a lot of trouble getting through your daily routine, social activities or work if you dont have anyone to talk to about your feelings. Your doctor or nurse can refer you to a specialist for help.About half of all people who have depression never get diagnosed or treated for the condition. Not knowing a person is depressed is the biggest hurdle to diagnosis and treatment. A lack of treatment can be life-threatening up to 15% of people with clinical depression commit suicide.
Coping After A Diagnosis Of Heart Disease
You may experience various types of emotional distress or behavioural disturbance. Problems such as depression and anxiety are especially common. These conditions not only affect your emotional state but can also impact on your symptoms of heart disease.
Fortunately, there are effective treatments for depression and anxiety available, including psychological interventions such as cognitive behaviour therapy and antidepressant medication.
Addressing these problems will make it easier to follow your heart disease treatment plan. Your healthcare professional will be able to help assess any concerns you have regarding your psychological wellbeing.
For more information regarding the types of treatment options for stress, see:
- Chest Heart & Stroke Scotland – for information on stress and anxiety
- Breathing Space – free, confidential phone and web-based service for people in Scotland experiencing low mood, depression or anxiety
- Our mental wellbeing information – for high-quality, trustworthy information on different aspects of mental health and wellbeing
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Incorporate Other Healthy Lifestyle Changes One At A Time
Dont try to fix everything at once. Thats especially true if one of the habits you want to break is smoking.
Quitting smoking can be difficult. If you smoke, talk with your health care professional to determine if you need medications or other help to quit. Therapies may include nicotine replacement or prescription medicines. You could also ask for a referral for a smoking cessation program.
Ultimately, you have to take care of yourself to break the cycle of feeling down. That could be doing something structured, such as a yoga class or tai chi practice, or something you can do anywhere, such as meditating, listening to music or reading a book.
Written by American Heart Association editorial staff and reviewed by science and medicine advisers. See our editorial policies and staff.
Last Reviewed: Jun 22, 2021
Joining A Cardiac Rehabiltation Programme
Watch this video from the British Heart Foundation on cardiac rehabilitation
A member of the cardiac rehabilitation team may visit you in hospital and give you information about your condition, the treatment youve had and your recovery.
You should also be invited to join a cardiac rehabilitation programme starting about four to eight weeks after you leave hospital.
You should be offered rehabilitation if youve had:
- angina or heart failure
- an ICD implanted
Some programmes take place in a hospital or community setting. These sessions will give you and your family the information, support and advice you need to get back to everyday life as well as possible.
Cardiac rehabilitation helps you:
- recover from your procedure, surgery or heart attack
- make changes to your lifestyle to protect your heart
- reduce the risk of further problems
You can find out where your nearest cardiac rehabilitation programme is by visiting Cardiac Rehabilitation or by phoning the British Heart Foundation Heart Helpline on .
Read more from British Heart Foundation
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Heart Disease And Mental Health Disorders
Mental health is an important part of overall health and refers to a persons emotional, psychological, and social well-being. Mental health involves how we think, feel, act, and make choices.
Mental health disorders can be short- or long-term and can interfere with a persons mood, behavior, thinking, and ability to relate to others. Various studies have shown the impact of trauma, depression, anxiety, and stress on the body, including stress on the heart.1-3
Can Depression Cause Heart Disease Or Heart Attack
When you experience depression, anxiety or stress your heart rate and blood pressure rise, theres reduced blood flow to the heart and your body produces higher levels of cortisol, a stress hormone. Over time, these effects can lead to heart disease. Depression and anxiety can also develop after cardiac events, including heart failure, stroke and heart attack.
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How Heart Failure Makes You Feel
When you’re diagnosed with a long-term disease like heart failure, it’s normal to feel a lot of different emotions, including:
- Fear about the future
- Worry you’ll lose control over your health
- Anger that you have heart failure, or that it interferes with your life
- Stress over your ability to manage your condition
- Loneliness because you worry other people don’t understand what you’re going through
If you have these feelings and let them build up, it could make matters worse. Stress and anger can raise your blood pressure and make your heart work even harder. Both can be as bad for your heart as high blood pressure and cholesterol.
Depression â which includes feeling sad for at least 2 weeks — affects up to 70% of people with heart failure. If you donât treat your depression, it might be harder for you to control your heart disease.
Women are more likely than men to say that they feel stressed and depressed. Men can feel that way, too, but they may be less likely to say so.
Effect Of A Positive Mental State On Heart Disease
Maintaining a positive attitude about treatment and holding the belief that our actions can have a beneficial effect on our own healthare very important. A persons attitude seems to have a powerfully favorable effect on their ability to make behavior and lifestyle changes that are often necessary to reduce the risk of having future heart problems. A persons attitude also influences the response to treatment. Two terms that are used when discussing the effect of a positive mental state on heart disease which include:
- Healthy adherer Several studies have examined how well or poorly people take their medicines. Those who take their medications as directed have a lower death rate than those who dont . Individuals with a positive attitude about taking medications may also diligently follow daily habits that are healthy for the heart, such as proper diet and exercise.
- Self-efficacy describes a persons beliefs about their ability to do certain things in order to reach a desired outcome, or to influence events in their life. The self-confidence that our actions can have a positive effect on our health is very important in determining how motivated we are to engage in behaviors that are good for us.
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Heart Event Recovery And Depression: Types Of Support
Individuals recovering from a heart attack or other serious cardiac event can find many types of support. These include cardiac rehabilitation, social groups, and more specialized evaluation and treatment by psychologists, psychiatrists, and psychiatric social workers.
- Cardiac rehabilitation You can find supervised forms of exercise in many clinical exercise centers around the country, including Johns Hopkins. Your closely monitored program may include an activity and nutrition plan specifically developed for heart attack recovery. Studies have shown that returning to normal activity and seeing the progress of other people recovering from a heart attack significantly improves mood and confidence.
- Social support Its natural to withdraw and lose social confidence after a heart attack. But according to some studies, making an extra effort to re-engage and socialize with friends can help you return to the person you were before, which can be vital to heart attack recovery.
- More formal forms of support Sometimes going back to a normal life after a heart attack requires the guidance of a psychiatrist, psychologist, or psychiatric social worker. Many milder forms of depression can be successfully treated by behavioral or talk therapy, either one-to-one or in a group of heart attack recovery patients. For some, depression symptoms may require antidepressant medication.
There Are Helpful Resources Available
As you adjust to living with heart failure, its important to know that youre not alone.
Barlow says there are support groups, individual mental health professionals, and some mental health professionals that specialize in helping people with chronic diseases.
Since a chronic illness can take a toll on your entire family unit, Barlow says close family members and caregivers may also want to seek out support groups and mental health experts. These types of groups are beneficial for everyone involved. The
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What Is Mental Health
However, according to the World Health Organization, mental health is about wellness and not merely the absence of a mental health condition. It is a state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community.
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- Mental health conditions like anxiety and depression can increase the risk of heart disease. Feeling lonely or being socially isolated can also affect your heart health.
- Anxiety and depression are common after a heart attack or heart surgery.
- The good news is that there are many ways you can look after your heart health and mental wellbeing, including talking to you doctor, attending cardiac rehabilitation, making healthy lifestyle changes and staying connected with others. If youre struggling to manage your physical and mental health, seek help the sooner, the better.
Differential Pathways Of Positive And Negative Health Behavior Change In Congestive Heart Failure Patients
- The SAGE Encyclopedia of Abnormal and Clinical Psychology2017
- Adolescent Health: A Multidisciplinary Approach to Theory, Research, and Intervention2005
- The International Handbook of Psychology2000
- The SAGE Handbook of Organizational Behavior: Volume I – Micro Approaches2008
- 21st Century Psychology: A Reference Handbook2008
- Sally S. Dickerson and more…Encyclopedia of Social Psychology
Early Signs Of A Mental Health Concern
The early signs of a mental health issue like depression are often seen by family members first.
Barlow says one common sign is a loss of interest in things that used to bring a person joy. Another is a lack of daily functioning, or, in other words, a reduced ability to manage different aspects of life on a day-to-day basis.
Since living with heart failure can lead to a wide range of emotions, it can be difficult to determine when these behaviors indicate a deeper mental health concern.
Thats why she encourages anyone with a chronic condition like heart failure especially a recent diagnosis to have an initial mental health evaluation. This can help prepare you for all the emotional aspects that are often linked with chronic disease.
People tend to internalize these feelings and dont know how to manage them properly, she explains.
Internalizing the emotional toll these chronic illnesses carry can certainly lead to depression and other mental health issues. Having an evaluation with a mental health professional might help you navigate and understand the life changes that will come along with such a diagnosis.
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How Depression And Heart Disease Relate To Each Other
Depression and heart disease are among the most disabling diseases we face. They are both very widespread among the general population and often occur simultaneously in the same individual.
There is thought to be a two-way relationship between heart disease and depression:
A percentage of people with no history of depression become depressed after a heart attack or after developing heart failure. And people with depression but no previously detected heart disease, seem to develop heart disease at a higher rate than the general population.
It is somewhat hard to prove that heart disease directly leads to the development of a first-ever episode of depression. That is because some people who have had previous episodes of depression may not have it formally diagnosed until they see their doctor for heart problems.
What we can say with certainty is that depression and heart disease often occur together, says Dr. Roy Ziegelstein, vice dean for education at the Johns Hopkins University School of Medicine . About one in five who have a heart attack are found to have depression soon after the heart attack. And its at least as prevalent in people who suffer heart failure.
Early Diagnosis Makes A Difference
If you think youve noticed signs of a mental health condition whether its depression, anxiety, or something else its important to contact your doctor right away.
Barlow says getting an early diagnosis is key to the effective treatment of mental health issues and heart failure.
Early intervention can help you make lifestyle adjustments and receive the proper mental health evaluation and treatment plan for the emotional concerns that come with a chronic disease like heart failure, she adds.
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Following A Treatment Plan
Undiagnosed or untreated depression or anxiety may impact your ability to follow a treatment plan for heart failure.
For example, it may affect your ability to stick to taking your medication as needed or making it to your healthcare appointments, explains Piña. Thats why she says cardiologists should try to identify mental health issues, and particularly depression and anxiety, as early as possible.
Plus, the Cleveland Clinic notes that lifestyle habits often linked to depression such as smoking, inactivity, drinking too much alcohol, poor dietary choices, and missing out on social connections can also have a negative effect on your heart failure treatment plan.
Congestive Heart Failure Drugs
There are several medications that can be used to treat CHF, including ACE inhibitors, beta-blockers, and more.
Angiotensin-converting enzyme inhibitors open up narrowed blood vessels to improve blood flow. Vasodilators are another option if you cant tolerate ACE inhibitors.
You may be prescribed one of the following:
voluntary recall of 5 lots of the drug Accupril due to the presence of nitrosamine. Nitrosamine, a known carcinogen with the potential to cause cancer, was found to exist in the drug at levels greater than the Acceptable Daily Intake as determined by the FDA. This recall is specific only to a handful of lot numbers and does not affect all Accupril tablets made by Pfizer. If you take Accupril tablets, talk with your pharmacist or doctor and they will help you determine if your medication has been impacted by the recall.
ACE inhibitors shouldnt be taken with the following medications without consulting a doctor, because they may cause an adverse reaction:
- Potassium-sparing diuretics and potassium supplements. These diuretics can cause potassium buildup in the blood, which may lead to abnormal heart rhythms. Examples include: riamterene , eplerenone , and spironolactone .
- Nonsteroidal anti-inflammatory drugs .NSAIDs such as ibuprofen, aspirin, and naproxen, can cause sodium and water retention. This may reduce the ACE inhibitors effect on your blood pressure.
This may be achieved with:
Your doctor may recommend:
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Talk With Your Provider About Symptoms To Report
Heart failure requires you and your caregivers to pay close attention to any changes in symptoms. If you notice something new, or a sudden worsening of a current symptom, notify your healthcare professional immediately.
- Rapid weight gain Ask your doctor about the amount of weight gain you should report to him or her. Its so important for people with heart failure to weigh themselves every day preferably every morning, before breakfast and after urinating. Try to weigh yourself daily with the same type of clothes on, without shoes, on the same scale and in the same spot.
- Shortness of breath while at rest, not related to exercise or exertion
- Increased swelling of the lower limbs
- Swelling of or pain in the abdomen
- Trouble sleeping
- Frequent dry, hacking cough
- Increased fatigue or feeling tired all the time
- Feelings of sadness such as depression.
What Is The Connection Between Mental Health Disorders And Heart Disease
A large and growing body of research shows that mental health is associated with risk factors for heart disease before a diagnosis of a mental health disorder and during treatment. These effects can arise both directly, through biological pathways, and indirectly, through risky health behaviors.5
People experiencing depression, anxiety, stress, and even PTSD over a long period of time may experience certain physiologic effects on the body, such as increased cardiac reactivity , reduced blood flow to the heart, and heightened levels of cortisol. Over time, these physiologic effects can lead to calcium buildup in the arteries, metabolic disease, and heart disease.1,6-11
Evidence shows that mental health disorderssuch as depression, anxiety, and PTSDcan develop after cardiac events, including heart failure, stroke, and heart attack.5,12-20 These disorders can be brought on after an acute heart disease event from factors including pain, fear of death or disability, and financial problems associated with the event.5,16
Some literature notes the impact of medicines used to treat mental health disorders on cardiometabolic disease risk. The use of some antipsychotic medications has been associated with obesity, insulin resistance, diabetes, heart attacks, atrial fibrillation, stroke, and death.21
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