Is it possible to separate the heart from the mind? The answer is “no”, according to specialists who gathered at the 39th Congress of the Society of Cardiology of the State of Rio de Janeiro (SOCERJ), an event held virtually in May. During a conference on mental health, doctors and psychologists recalled that long-term data have suggested that people who are under stress are more likely to have cardiovascular events. Takotsubo cardiomyopathy (TCM) is an extreme example of this.
Several different articles in the scientific literature show how negative emotions affect physical health. According to one of the presenters, Gustavo Barbirato, MD, cardiologist and member of the Department of Spirituality and Cardiovascular Medicine (DEMCA) of the Brazilian Society of Cardiology (SBC), A study made during the 2006 World Cup in Germany, and published in the New England Journal of Medicine early 2008, showed, for example, that watching a stressful football game more than doubles the risk of an acute cardiovascular event.
In contrast, positive emotions have been associated with beneficial effects. Barbirato pointed out that clinical studies have revealed that gratitude, optimism, religiosity and forgiveness therapy, for example, appear to contribute to the reduction of risk factors related to stress and cardiovascular events. He went on to explain that there are already studies suggesting that this approach can help patients change their attitude towards some illnesses (such as hypertension and heart failure) and reduce blood pressure levels. It can also improve treatment compliance. It is important to remember that, despite the benefit of alternative therapies such as meditation, mindfulness, and yoga, they are not a substitute for medical or mental health care when needed.
Researchers at Harvard University in Cambridge, Massachusetts, have been studying the relationship between happiness and longevity since 1938. According to Dr. Cláudio Domênico, PhD, clinical cardiologist at Hospital Pro‑Cardiac, Rio de Janeiro, and moderator of the scientific session , the Harvard Study of Adult Development A study by Robert Waldinger, MD, and colleagues has shown that a person’s level of satisfaction with their relationships and social connections at age 50 was a better predictor of aging than their cholesterol levels.
Considerations for the elderly
For Kalil Lays Mohallem, MD, cardiologist and geriatrician at Pro-Cardiac Hospital, every primary care physician must investigate two critical aspects in elderly patients: cognitive deficit and depression.
Regarding cognitive deficit, Mohallem recalled that it has already been shown that triage is not beneficial for those who do not have complaints; that is, it is only worth investigating the possibility of a cognitive deficit in those with complaints or when relatives report signs that could indicate a problem.
However, in terms of depression, it is crucial to remember that depressed patients do not always feel sad or crying, as Mohallem reminds us. “Patients often come in with a physical problem or complaint that is unclear, having made many appointments to see several different doctors. These cases are worth investigating,” he emphasized.
He went on to explain that specific tools, such as the Geriatric Depression Scale (GDS), could be used for this purpose. Doctors may also ask patients if they’ve felt a loss of interest in things they used to enjoy, and perhaps feel like they have less energy or can’t cope with daily activities. If the answer to any of these questions is “yes”, more research may be needed.
According to Lilian Scheinkman, MD, a psychiatrist and professor at the Rio de Janeiro State University (UERJ), patients with depression who experience acute myocardial infarction and coronary heart disease have significantly higher rates of mortality and morbidity. Physicians should therefore be aware of this and assess and refer patients to a specialist when necessary.
The specialists also highlighted the importance of practicing physical activity, as well as the advantages of adopting a multidisciplinary approach. For them, when health professionals with specializations in various fields work together, patients can receive comprehensive care and it is easier to monitor the impact of various medications, which is particularly important for elderly patients. “All psychotropic and nonpsychotropic drugs have their own side effects and drug interactions,” Scheinkman said, emphasizing the need for judicious monitoring and individualized treatment plans.
Mental health and cardiovascular health are closely linked, as explained by Dr. Natalia Telles, psychologist and coordinator of the Department of Psychology at Hospital Pro-Cardiaco. “What patient with a cardiac problem, such as arrhythmia or precordial pain, is not going to feel anxious, apprehensive or fearful of dying?” Telles asked, while she stressed that the differential diagnosis of comorbidities is an important issue.
Also, one factor may increase the risk of another. “We know that a very anxious patient is more likely to have a cardiovascular problem and vice versa,” she noted, reinforcing the need for teamwork in treating these patients. Telles also believes that elderly care is a good example, because it often requires health professionals to be in contact with each other. “It’s the blueprint for how we should treat patients of all age groups,” she said.
Effects of the pandemic
Domênico explained that, for the French social scientist Edgar Morin, the COVID-19 pandemic posed a challenge for humanity: the need to develop a tolerance for the unknown. This is particularly daunting, since we live under the illusion that we are in control, he said.
Although we don’t really have control over things, this illusion helps us to be more organized and disciplined. “The pandemic came to destroy this illusion,” Scheinkman said.
Telles added that the uncertainties imposed by the new coronavirus “put life on hold.” By that, she meant that desires and motivation were put on hold and people’s lives became more and more restricted.
In turn, this impact on social life has an impact on mental health, especially with regard to an increasing number of cases of compulsive eating, alcohol and drug use/abuse, depression, panic disorders and insomnia.
Scheinkman also noted a significant daily increase in seeking professional help in the form of psychiatric and mental health care. “I think there was a significant increase in people’s suffering,” she said, adding that two groups particularly affected by the pandemic were older adults and teenagers.
Another theme that became more prominent during the pandemic was burnout. “Work invaded the home, so that period between going to work and leaving at the end of the day ceased to exist,” Telles said. He went on to point out that the challenge was even more important for health professionals.
Mohallem emphasized the importance of primary care physicians being mindful of their own health. “We have to take care of our own mental health. I can’t take care of other people if I don’t take care of myself,” he said.
This article was translated from Portuguese edition of Medscape.
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