Psychocardiology

Psychocardiology - Heart & Mind Link

• Studies interplay between psychological factors & cardiovascular disease (CVD).
• Key Psychological Risk Factors:
  • Depression, anxiety disorders (e.g., GAD, Panic).
  • Chronic stress, PTSD.
  • Type D Personality (distressed: negative affectivity + social inhibition).
• Impact: ↑ CVD incidence & prevalence, poorer prognosis, ↑ cardiac events & mortality.
• Mechanisms:
  • Behavioral: Smoking, poor diet, sedentary lifestyle, medication non-adherence.
  • Physiological: HPA axis dysregulation, ↑ inflammation (e.g., CRP), autonomic dysfunction, endothelial dysfunction.

⭐ Depression after Myocardial Infarction (MI) significantly increases risk of re-infarction and mortality by 2-2.5 times.

Psychocardiology - Shrink-ing Hearts

• Examines interplay between psychological factors & cardiovascular health (mind-heart connection).
• Key psychological risk factors:
  • Depression: ↑ CVD risk & mortality.
  • Anxiety disorders: can mimic or exacerbate cardiac symptoms.
  • Chronic stress: contributes via HPA axis, inflammation.
  • Type D Personality (distressed): negative affectivity, social inhibition.
• Mechanisms: Autonomic dysfunction, ↑ inflammatory markers (e.g., CRP, IL-6), endothelial dysfunction, unhealthy lifestyle choices.
• Specific links:
  • Takotsubo cardiomyopathy (stress-induced).
  • Post-MI depression (affects ~20% of patients, worsens prognosis).
• Management: Screening, psychotherapy (CBT), psychopharmacology (e.g., SSRIs generally safe post-MI).

⭐ Depression is an independent risk factor for developing coronary artery disease and is associated with poorer outcomes and increased mortality post-myocardial infarction (MI).

Psychocardiology - Psyche Meds, Heart Effects

• Antipsychotics (APs)
  • QTc Prolongation:
    • High risk: Thioridazine, Ziprasidone, IV Haloperidol.
    • Monitor ECG.
  • Orthostatic Hypotension:
    • Low-potency FGAs (Chlorpromazine), Risperidone, Clozapine.
  • Myocarditis:
    • ⚠️ Clozapine (baseline/regular ECG, Troponin, CRP).
  • Tachycardia: Clozapine, Olanzapine.
• Antidepressants
  • TCAs (e.g., Amitriptyline):
    • QTc prolongation, orthostatic hypotension, arrhythmias.
    • 📌 Tri-Cyclics = Tri-Cardiac effects.
  • SSRIs:
    • Citalopram (max 40mg), Escitalopram (max 20mg) → QTc prolongation.
  • SNRIs (Venlafaxine): ↑BP, ↑HR.
• Mood Stabilizers
  • Lithium: T-wave changes, bradycardia, SA dysfunction.
  • Carbamazepine: Bradycardia, AV block.
• Stimulants
  • Methylphenidate, Amphetamine: ↑BP, ↑HR.

⭐ Clozapine carries a risk of myocarditis, typically in first 2 months of treatment; monitor with ECG, troponin, and CRP.

Psychocardiology - Broken Hearts, Troubled Minds

• Bidirectional link: heart disease ↔ mental health. Focus: psychiatric sequelae in cardiac patients.
• Common: Depression (20-40% post-MI), Anxiety (GAD, Panic), PTSD (post-MI/CABG), Delirium.
• Impact: ↑ morbidity & mortality, ↓ QoL & adherence.
• Key Syndromes:
  • Takotsubo Cardiomyopathy ("Broken Heart Syndrome"): Acute stress-induced.
  • Type D Personality: Negative affectivity, social inhibition → poor cardiac prognosis.
• Management: Screening, psychotherapy (CBT), SSRIs (cardiac safety crucial), lifestyle changes.

⭐ Depression is an independent risk factor for adverse cardiovascular outcomes in patients with established heart disease.

Psychocardiology - Healing Heart & Soul

• Interface of cardiology & psychiatry; manages psychological distress in cardiac patients.
• Common conditions: Depression (post-MI), anxiety disorders, Type D personality (distressed).
• Impact: Affects medication adherence, Quality of Life (QoL), morbidity, & mortality.
• Management:
  • Pharmacotherapy: SSRIs (e.g., Sertraline, Escitalopram) generally safe.
  • Psychotherapy: Cognitive Behavioral Therapy (CBT), supportive therapy.
  • Lifestyle: Stress management, cardiac rehabilitation.

⭐ Depression is an independent risk factor for adverse cardiovascular outcomes, including mortality, especially post-Myocardial Infarction (MI).

High‑Yield Points - ⚡ Biggest Takeaways

• Depression is an independent risk factor for CAD and worsens post-MI prognosis.
• Anxiety disorders, especially panic disorder, can mimic cardiac symptoms.
• SSRIs (e.g., Sertraline) are first-line antidepressants in cardiac patients due to cardiac safety.
• TCAs and some antipsychotics risk QTc prolongation and arrhythmias.
• Takotsubo cardiomyopathy is precipitated by intense emotional/physical stress.
• Type D personality (negative affectivity, social inhibition) is linked to poorer cardiovascular outcomes.