12.3 Physiological aspects of Heart Disease

Question 1

How are phychosocial factors related to heart disease?

Answer 1

Psychosocial factors can affect heart disease through:

• Socio-demographic factors associated with risk and accessibility of health care services
• Lifestyle factors
• Triggering cardiac events
• Beliefs influencing use of medical care

Question 2

What are the psychosocial risk factors for heart disease?

Answer 2

Studies have identified chronic and acute risk factors:

• Socio-economic status
• Lifestyle
• Stress and strain
• Hostility/anger
• Social isolation
• Depression and anxiety

Question 3

Explain how hostilty/anger is a psychosocial risk factor of heart disease

Answer 3

• It is an example of a component of type A behaviour
• It is measured by self-report questionnaire (or interview)
• Greater physiological reactivity (& likelihood of encountering stress) to stressors leading to:
  
  • ​Increased BP
  • Adrenaline (release)
  • Noradrenaline (release)
  • Cortisol (release)
• Anger can trigger MI
• Hostility REDUCES social support
• These individuals often:
  
  • Negative health behaviours
  • Ignore/deny symptoms
  • Frustrated attempts to control events - can lead to depression and exhaustion
  • Behaviour - can lead to acute stress

Question 4

Explain what stress & heart disease can cause (& 2 pathways)

Answer 4

• Chronic high levels of stress may INCREASE cardiovascular reactivity
• Reactivity is related to family history, physical fitness and support
• Hyper-reactivity is not associated with the development of heart disease in healthy populations
  
  • But, hyper-reactivity is associated with the development of HYPERTENSION

Question 5

What is the definition of allostatic load?

Answer 5

Allostatic load - physiological toll of repeatedly adapting to chronic stressors - the effects are cumulative

Question 6

Explain how different studies have lead to proving that stress can INCREASE risk of diseases (e.g. heart disease)

Answer 6

• Epidemiological studies (prospective)
  
  • Chronic stress → atherosclerosis
• Clinical studies (retrospective)
  
  • Acute stress is associated with acute coronary syndrome in those with atherosclerosis
• Laboratory studies (controlled variables)
  
  • Stressors, e.g. giving a public speech increases heart rate and BP (more so in individuals with pre-existing ischaemia)

Question 7

What factors give the experience of disease?

Answer 7

Question 8

Explain the self-regulatory model of illness behaviour

Answer 8

Question 9

Explain how cognitive responses can lead to different outcomes

Answer 9

• Controllability and curability of illness
  
  • Leads to percentage attendance at rehabilitation
• Less serious consequences –> QUICKER return to work & BETTER social functioning

Behaviour related to beliefs

Question 10

Explain how emotional responses are linked to heart disease (& typical temporal pattern of anxiety after MI)

Answer 10

ANXIETY

• Physical symptoms of anxiety may be confused with symptoms of heart disease
• Many develop PTSD
  
  • ​Very hard to predict WHO will be affected (use HADS score)

Question 11

What are the sources of anxiety?

Answer 11

• Investigations
• Discharge
• Fear of over-exertion
• Family’s fears

Question 12

Explain depression link to heart disease (& predictors of depression & questions to ask patient)

Answer 12

• Can be co-morbidity with anxiety
• Is highly linked to 2nd MI & death
  
  • Screening for depression (NICE)
    
    • ‘During the last month, have you often been bothered by feeling down, depressed or hopeless?’
    • ‘During the last month, have you often been bothered by having little interest or pleasure in doing things?’
  • Answering ‘YES’ to either question = indicator of depression
• Predictors of depression:
  
  • Young
  • Female
  • Isolated

Question 13

How does depression affect prognosis? (different pathways and what could happen due to this)

Answer 13

Question 14

What are the implications of anxiety & depression on behaviour?

Answer 14

• Delay in returning to work
• Low ratings of social satisfaction
• Reduction in sexual activity - impact on relationships and self-confidence
• Poorer adherence but more likely to attend doctors with general worries
• Negative impact on lifestyle and quality of life

Question 15

What is the aim of cardiac rehabilitation?

What is the objective of cardiac rehabilitation?

Answer 15

Aim: To help patient recover as quickly and completely as possible and to reduce to a minimum the chance of recurrence of the cardiac illness (is individualised to each patient, reduces mortality significantly)

Modify behavioural risk factors: (financial benefit to health service providers)

• Lifestyle factors, e.g. unhealthy diet, smoking, lack of exercise
• Type A behaviour
• Stress
• Improve psychological functioning
• Improve quality of life

Question 16

What is the definition of rehabilitation?

Answer 16

The sum of activities required to influence favourably the underlying cause of the disease, as well as the best possible physical, mental and social conditions, so that they may, by their own efforts, preserve (or resume when lost) as normal as possible a place in the community

Question 17

What are the long term benefits of cardiac rehabilitation?

Answer 17

After 12 months:

• Differences in psychosocial benefits decline
• Differences in physical benefits decline
  
  • Patients drop out when they feel better
  • Need continuing support and guidance for benefits to continue
  • Risk factor reduction needs regular activity to be sustained
• Probably cost effective and quality of life is improved
• Secondary MI prevention INCREASED