Psychosocial aspects of surviving sudden cardiac death

Abstract

Summary:The psychosocial problems faced by the survivor of "sudden cardiac death" are discussed from the point of view of the patient, the family, and the physician. The patient faces a battery of intensive diagnostic tests, as well as concern for future capability to resume function as "spouse, parent, and citizen." Emotions such as depression, anger, anxiety, frustration, and fear must be dealt with in a constructive manner. Management includes education, support, encouragement of adaptive denial, anxiolytic medication if necessary, and relaxation techniques when helpful. Our approach begins with education of the patient and family in regard to the medical aspects of the illness. Next, we provide support for the patient and allow the patient to express his or her concerns at an individual pace. Adaptive denial is encouraged and maladaptive denial addressed. Appropriate medication is prescribed when necessary, and finally, relaxation techniques may have a role in some patients. A strong physician-patient relationship is necessary for successful evaluation and therapy. The unique stresses of the cardiologist and the electrophysiology team are described.

Partner Quality of Life in the Antiarrhythmics Versus Implantable Defibrillators Trial

“…Our findings of diminished concerns over time confirm the findings of others with respect to partners and patients with ICD, but our study is the first documentation of this for partners and patients treated with AAD. 21,27,28 Limitations This exploratory study has the largest sample of ICD partners reported to date, but the size of the partner group was small and subjects were self-selected volunteers. Diversity of subjects was limited and consisted mostly of white females older than 60 years.…”

The Natural History of Recovery Following Sudden Cardiac Arrest and Internal Cardioverter‐Defibrillator Implantation

“…SCA survivors report the highest levels of anxiety, depression, anger, stress, and denial within 6 months of being discharged from the hospital, with a gradual return to pre‐SCA levels at 1 year 10,26 . During this time, SCA survivors have described feeling more anxious, depressed, fearful, irritable, helpless, unable to sleep, and less in control 20,27,28 . Once the early recovery period has been successfully completed, individuals begin to develop a sense of security with the ICD, and acceptance of the device is high.…”

Psychiatric Treatment Strategies for Patients at Risk of Dying Suddenly

“…MI) not only do patients suffer psychologically but spouses may be equally distressed and in some (e.g. early stages) may even be more symptomatic [7], Common initial reactions are fear and over protection (especially hypervigilance) to ward the patient but spouses are also afraid for themselves and their families [6], Symp toms are most marked soon after an event. All patients, spouses and available children arc referred for family assessment and initial counseling.…”

“…Their role as person, spouse, parent and provider is affected. Anxiety is often marked as the patient undergoes the various evaluative procedures [5,6], The majority of patients with LTVAs that we have surveyed have an 'adjustment disorder' although in the light of the magnitude of the various stressors, this diagnosis may be a misnomer. After the acute danger has passed, symptoms tend to dissipate rapidly although in some cases depression may then surface.…”