Psychocardiology: Information & Specialists

Psychocardiology is a specialty within human medicine. Psychocardiologists study the connection between heart disease and mental well-being.

Studies in psychocardiology show that heart disease can be accompanied by psychological problems such as

• depression,
• anxiety disorders, and
• post-traumatic stress disorder

.

Conversely, depression and anxiety can also increase the risk of developing heart disease.

The inpatient psychocardiological treatment developed within the field of psychocardiology consists of

• internal medicine and cardiology care, as well as
• psychosomatic (mind-body) diagnosis and treatment

.

It has long been known that there is a connection between heart disease and mental well-being. For several decades now, science has also been studying this phenomenon. This led to the emergence of the field of psychocardiology.

Psychocardiology shows that mental well-being influences

• behavior (e.g., “emotional eating,” smoking to relieve stress) as well as
• changes in the body’s regulatory processes

 affects the heart.

Stress and Heart Disease

Chronic stress can lead to disturbances in the autonomic nervous system. This can result in disturbances in the regulation of 

• heart rate,
• blood pressure, and
• blood flow 

. This leads to an increased tendency for blood to clot, with the risk of clot formation, e.g., in the coronary arteries. Such narrowing of blood vessels can have serious health consequences. Stress-related disruptions in hormonal balance and inflammatory processes can contribute to this.

Over the long term, stress can contribute to the development of narrowing in the coronary arteries. In the short term, it can

• heart attacks,
• cardiac arrhythmias, and
• acute heart failure, known as “broken heart syndrome,”

. This is often triggered by factors such as spikes in blood pressure, for example due to acute stress or anger.

Heart Disease and Depression

People with depression have a particularly elevated risk of cardiovascular disease. According to the findings of numerous studies, depression increases the risk of a heart attack to a degree similar to that of smoking. Even mild depressive symptoms lead to a measurable increase in risk, similar to that seen with secondhand smoke.

Conversely, heart disease increases the risk of developing depression. Heart disease itself places a considerable burden on many patients and their families. In addition to depression, anxiety disorders or psychosomatic symptoms may also occur as a result of heart disease.

Anxiety Disorders Caused by Heart Disease

After a heart attack or a severe arrhythmia, many patients live in constant worry. They fear that such an event could happen again. They may first notice harmless extra heartbeats—which occur in most healthy people—and interpret them as a threat.

Even everyday sensations of discomfort in the chest area can be misinterpreted as warning signs of a heart attack. This leads to intense anxiety, which can escalate into panic. This, in turn, accelerates the heart rate, creating a vicious cycle of anxiety and palpitations.

These symptoms often end up having a greater impact on daily life than the actual heart damage itself. Repeated medical examinations without conclusive results frustrate patients.

For some patients, this leads to premature disability. This is unfortunate because the affected individual would still be physically capable of performing their job.

Psychological Trauma Caused by Heart Disease

For some patients, heart disease represents a particular form of psychological trauma. This was particularly evident in patients who had suffered

• severe heart attacks,
• resuscitation procedures, or
• treatment of cardiac arrhythmias using electrical defibrillator shocks

.

These co-occurring mental health issues thus impair the overall quality of life for many heart patients. Their ability to implement medically recommended lifestyle changes is also diminished.

Those who are already discouraged find it particularly difficult to

• to initially make the seemingly burdensome changes to long-standing dietary habits
• to become more physically active again, or
• quit smoking.

Depressed or anxious patients also find it difficult to take their necessary heart medications regularly. Fears of side effects actually make these side effects more likely to occur, leading to the discontinuation of effective medications.

Depressive hopelessness impairs the willingness to take medication regularly in order to avoid complications from heart disease in a future that already seems hardly worth living. This is especially true when the side effects themselves further diminish one’s zest for life.

Sexual Dysfunction in Heart Patients

Sexual dysfunction is also a common problem. It is often the result of circulatory disorders or conditions associated with heart disease. At least half of heart patients suffer from it.

Both partners are also often unsure whether sexual activity might be too strenuous given the heart condition. In most cases, however, this is not the case. Out of embarrassment, patients avoid discussing this topic even with their doctor, and the doctor does not bring it up either. As a result, no help is available.

When a medication (or the fear of its side effects) brings their sex life to a complete standstill, discontinuing the medication often seems like the only option.

The Need to Treat Co-occurring Mental Health Issues in Heart Patients

Heart disease can often be successfully treated. However, the adverse effects of anxiety, depression, and post-traumatic stress disorders often exacerbate the disease or its treatment. Many patients are unable to cope psychologically with their condition and end up standing in the way of their own therapy.

The majority of cardiology guidelines therefore call for the systematic identification and treatment of comorbid mental health conditions in patients with heart disease.

Various treatment options are available for

• heart patients with co-occurring mental health issues, as well as
• patients with so-called functional heart symptoms without organic heart disease

:

Consultation with a primary care physician or cardiologist

The first step is a trusting conversation with your primary care physician or cardiologist. As part of basic psychosomatic care, they can provide support to help you cope with your condition.

What is important here

• that the doctor takes symptoms seriously—even those that cannot be fully explained by physical factors—and
• providing sound advice on the connections between heart function and psychological or physical stress, and
• if necessary, addressing issues in family or work life.

Physical Activity

In most cases, regular, moderate physical endurance exercise is also helpful. It strengthens both the cardiovascular system and self-confidence. However, the patient must enjoy the activity so that it can become a daily habit.

Antidepressants for Heart Patients with Depression and Anxiety Disorders

In cases of severe depression or anxiety disorders, antidepressant medications may also be used as a supportive treatment. However, numerous antidepressants—including newer ones—can cause cardiac dysfunction and other side effects. Undesirable interactions may also occur, such as an increased risk of bleeding. Unfortunately, antidepressants and heart medications often do not mix well when taken together.

Nevertheless, taking antidepressants is advisable in many cases. This, however, requires careful selection of the active ingredient by a physician with expertise in psychocardiology. Regular laboratory tests and ECG monitoring are also recommended in this regard.

Psychotherapy for Heart Patients with Depression and Anxiety Disorders

Anxiety disorders and depression can be treated very effectively with psychotherapy.

Most psychotherapy approaches do not initially take into account the specific challenges faced by heart patients. However, in recent years, many psychotherapists have obtained additional training in treating heart patients.

Psychotherapies developed specifically for heart patients have been tested with good results in recent years. In addition to alleviating psychological distress and improving quality of life, they may even have a positive impact on the physical course of the disease.

However, such services are currently available only at a few specialized centers.

Some patients cannot be treated on an outpatient basis due to the severity of their heart disease and/or accompanying mental health conditions. A few clinics offer inpatient psychocardiological treatment for such patients.

So far, however, this has primarily been limited to the field of rehabilitation. Some rehabilitation clinics offer more comprehensive psychocardiological treatment programs.

The psychocardiology treatment, which typically lasts 4 to 6 weeks, involves

• cardiologists,
• psychosomatic specialists, and
• psychologists, as well as
• nurses and
• specialist therapists

work as a team with the patients. The services include

• internal medicine and cardiology care, as well as diagnostics when necessary,
• regular rounds, and
• using all the technical resources of the Heart Center.

In addition, intensive psychosomatic diagnosis and treatment are provided simultaneously. This includes, among other things,

• regular individual and group psychotherapy sessions,
• patient education,
• art therapy, and
• relaxation exercises.

In addition, every patient receives physical therapy aimed at

• general physical activation,
• improving body awareness, and
• physical training tailored to their specific medical condition.

If necessary,

• stress assessment,
• biofeedback, and
• social counseling

may be used.

Who is inpatient psychocardiological treatment suitable for?

Inpatient psychocardiological treatment is particularly suitable for patients with

• heart disease involving psychological factors or comorbid mental health conditions,
• pronounced risk-taking behavior or stress-processing disorders leading to resulting complications, e.g., recurrent uncontrolled hypertension or diabetes,
• pronounced physical symptoms with no organic cause or with an as-yet-unclear organic cause (including “cardiac neuroses”). This is especially true if these symptoms have already led to repeated emergency visits or extensive examinations without a sufficient explanation for the symptoms