Feelings After a Heart Attack (Part three)

The third installment of our four-part After A Heart Attack series

People typically have a spectrum of emotions after a heart attack. Common feelings include fear, anxiety, depression, anger, loneliness — but also hope for the future as well as relief at having another chance.

Dr. Barry Jacobs

According to psychologist Barry Jacobs, the Director of Behavioral Sciences for the Crozer-Keystone Family Medicine Residency Program in Springfield, Pennsylvania, and co-author of AARP Meditations for Caregivers—Practical, Emotional and Spiritual Support for You and Your Family, there’s often an initial sense of shock — ‘I just didn’t see it coming,’ followed by fear of what may come — ‘can I ever feel safe again?’ “Beyond that anxiety, we know about 20 percent of people who have heart attacks, as well as those who have heart surgery, will have depression afterwards,” he said.

The difference between sadness and depression

Sadness is how people respond to loss so it is a normal and expectable emotion in response to a heart attack. “When people have a heart attack, they may lose many things — the ability to engage in certain physical activities, duties at work or the illusion that they’re invulnerable,” Jacobs said. Typically, this sadness resolves itself as survivors adapt to a new normal and find new meaning and satisfaction.

Jacobs characterized depression, on the other hand, as a response above and beyond sadness, a kind of overwhelming grief and a sense of hopelessness. Often it is accompanied by changes in sleep, appetite and energy level — a general inability to enjoy life. “People who are sad usually can go about functioning adequately in their normal daily routines,” Jacobs said. “People who are depressed are debilitated to the point that they can’t work very efficiently. They can’t fulfill their family functions. They don’t see much hope in the future. They may feel guilt, sometimes overwhelming guilt, about things they’ve done or not done from the past. People who are depressed are truly ill, and they need treatment for that illness.”

The difference between worry and anxiety

Like sadness, worry is a normal, expectable response to something troublesome that has happened. If you didn’t know you had heart disease and so weren’t expecting a heart attack, you naturally might be worried about your condition and having another one. “This worry can be a good thing if it mobilizes the survivor to take care of themselves,” Jacobs said. “Worry is something people do and then let go of. It doesn’t dominate their lives.”

Anxiety is worry magnified. Instead of concern about negative news, it is focusing on the disastrous outcome it portends. “Anxiety is uncontrollable worry, where thoughts about all the bad things that can happen dominate the patient’s mind,” Jacobs said. “They ruminate on potential catastrophes, and this rumination really detracts from their quality of life. It decreases their capacity to concentrate and enjoy their lives.”

Anxiety often accompanies depression as people who feel hopeless and helpless tend to be anxious about the future, but Jacobs emphasizes that they are separate conditions. See guidance on managing fear and anxiety after a heart attack from Heart Insight Spring 2016.

How stress impacts feelings

“Stress occurs when we have to adapt to any change in our environment,” Jacobs said. For example, winning the lottery would likely produce stress as we learned to handle all that money. “However, what happens in situations where there is high stress, for instance, a medical crisis, is that it tends to make people more likely to become depressed and anxious.”

Stress is not something we “cure” since life is dynamic and we are constantly adapting to change. The issue is one of management, how can we manage stress? Well, you can either manage the input or you can manage the impact.

“Certain things are very good for reducing stress — being an effective time manager, planning ahead, getting things done early, not leaving things for the last minute,” Jacobs said. “When people get adequate sleep — 7-8 hours a night — they’re more impervious to stress. Physical exercise helps people reduce whatever tension they’re feeling.”

Jacobs suggests that survivors develop a mental wellness plan to help them manage their stress, especially if they are returning to work. “A mental wellness plan consists of certain things that we do every day: meditate, exercise, journal. An opportunity to reflect on the day. If we’re just working all the time, we don’t have the opportunity to replenish ourselves so that we can face problems with our best efforts.”

Positive emotions

While the outcome of a heart attack can certainly be tragic, surviving one can also be the source of positive emotions. Relief and gratitude are common survivor emotions. “People may have the sense that they were saved by God or that God was teaching them an important lesson, and they will live their life differently because of that,” Jacobs said. “Not everyone has positive emotions; not everyone has negative emotions. People respond in different ways.”

Whatever your emotions, get support

Emotional support improves a survivor’s recovery. “Families are extremely important. They encourage survivors to eat right, take their medicines, do their exercise,” Jacobs said. “Loved ones help patients make better choices, which improves clinical outcomes and helps survivors feel better about themselves.”

Beyond family support, there is community support that comes from neighbors and friends, from church, synagogue or mosque. “I think when people know that others are praying for them, there is a great sense of comfort, and they want to do well and demonstrate that they are, in fact, recovering,” he said.

Finding support with others who’ve experienced heart attack may also help. This is one of the many benefits of completing a cardiac rehabilitation. You may also find the AHA’s Support Network helpful. The Support Network is a valuable and easy-to-use social media platform designed to support the emotional needs of survivors and their loved ones.

Sometimes, however, this informal support is not enough. “If you’re having difficulty turning your attention to other aspects of your life because you’re consumed with your heart attack and fears of the future to the extent that you can’t function adequately, that’s a problem,” Jacobs said. Signs of depression and anxiety are difficulty sleeping; changes in appetite; decreased concentration; waking up each day with a sense of dread. “Those sorts of changes in sleep and appetite and just overall changes in functioning are signs that people should meet with their primary care provider, who can evaluate whether these feelings are an adjustment reaction or full-blown clinical depression or anxiety.”

For the most part, people don’t wrestle those emotions into submission on their own, so it is important to get help. “Depression is a risk factor for cardiac mortality, just like smoking or bad diet. Depressed survivors make poorer health choices,” Jacobs said. “They are less likely to take their medications and more likely to engage in behavior that increases the risk of a heart attack.”

The good news is that depression responds well to treatment, either with anti-depressant medications or some kind of talk therapy or a combination of both.

Riding the Roller Coaster

Survivor Melissa Murphy with husband Joe

After her heart attack at age 40, Melissa Murphy of Johnston, Iowa, had a plethora of emotions: fear, anger, sadness, disbelief, frustration, anxiety. She had been a nurse on an open-heart surgery team, so she knew the mechanics of a heart attack, but her own experience — the result of a right coronary artery dissection and the catheter insertion of two stents — made it profoundly real.

Initially she was shocked that such a thing could happen to her, a working mother of two, without apparent risk factors and who ran half marathons. After the shock, there was anger: “I was mad because I felt like my normal had been taken away from me,” she said. Then the anxiety set in: “I was just very vulnerable — if this could happen to me one night while I was sleeping, when was it going to happen again?”

These feelings of fear and anxiety have been exacerbated by two vasospasms (when the smooth muscle of a blood vessel contracts causing it to narrow) severe enough that she went to the emergency room, certain that she was having another heart attack. Ten months out from her surgery, she still has pain almost every day. “Any chest pain causes me to wonder, should I go to the hospital? Is this my stent closing?” she said. Her cardiologist assures her that the vasospasms will go away when they get her medication right, but she feels frustrated because she can’t start running again until they stop.

Melissa says that her recovery has been an emotional roller coaster. “You’re excited to be up and sitting on the couch, but you’re also depressed and sad because you can’t get up and just go do what you want to do,” she said. “You can’t make that peanut butter and jelly sandwich for your daughter’s lunch because you’re short of breath walking from the couch to the kitchen.

“Then the next day, something might snap you out of it, and you’re like, ‘Okay, I’m alive and need to live each day to the fullest’ to then having anxiety, ‘if I push myself and go for a walk around the block, will my heart sustain that activity?’ Every day is different.”

The vasospasms remind her every day that she has two stents keeping her coronary artery open. Her experience as a nurse does not necessarily calm her feelings about that: “It’s scary when you really think about it, you have these tiny little stents that are really what saved your life,” she said. “Obviously, my body doesn’t want these foreign things in my arteries because they’re vasospasming.” But knowing she needs to keep her blood thin, she is diligent about taking her medication. Even the bruising that is a result of her blood thinner can be consoling: “I’ll bump my leg and have a big bruise, and think, ‘Wow, my blood thinners are working.’”

This past August she took son Parker for his school physical and was filling out the paperwork. At the family history question it asked whether anybody in the family had had a heart attack. “This was the first year I had to check that box,” she said. “That hit me pretty hard because now my longevity and my kids’ health history have been affected by something that I had no control over. You try to eat right and exercise and do the right things, and then something completely off the radar affects your heart.”

Surviving a heart attack has changed the way she feels about her family: nobody gets out of the house without a hug. “My husband, Joe, has been my rock throughout this crazy journey,” she said. “He never panicked, he just thought about how to move through this and make sure the kids were okay.”

She has talked to her two children — Brenna, age 11, and Parker, 16 — but says the two hospital visits for chest pain in less than a year set them back a little bit.

“I talked to them both, individually, and told them that tomorrow is never guaranteed and we have to live each day to the fullest. As long as I’m talking to you, I’m good and you don’t need to worry. But I know they still continue to worry,” she said.

Melissa did a dozen sessions of cardiac rehab and says that was great emotional support as well as good physical conditioning: “I didn’t go to a counselor. That cardiac rehab group and the nurses were the best support group because everybody is going through the same thing,” she said. “It was great to see that I was not alone.”

Another way Melissa got support was blogging, but the support of her family made the biggest difference. She is also a big proponent of the American Heart Association Support Network: “People blog on that, and there are open forums where you can meet people and chat,” she said. “If you’re feeling really bad, I urge people to go talk to someone, get treatment. Your heart attack is one event, it shouldn’t define your whole life. You have to move forward because you’ve been given a second chance. Do what you can do today to assure tomorrow — take your meds, eat right, exercise.”

Which brings up the other end of the feeling spectrum — positive emotions. Her son got confirmed this year and at first she was sad, realizing she almost wasn’t there for it. “Then within a second, I thought, ‘Wow, it’s a blessing that I’m here.’ Now any time fear or stress or a negative emotion comes into my mind, I always think, ‘God has given me every day to live to the fullest so I’d better not waste it.’”

The Murphys on vacation with son Parker and daughter Brenna

See all of our After a Heart Attack series: 

After A Heart Attack, What Happens Now? (Part One)

Up & At 'Em, Cardiac Rehab Makes a Big Difference (Part Two) 

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