Elsevier

Critical Care Clinics

Volume 33, Issue 3, July 2017, Pages 619-634
Critical Care Clinics

Psychiatric Aspects of Heart Disease (and Cardiac Aspects of Psychiatric Disease) in Critical Care

https://doi.org/10.1016/j.ccc.2017.03.004Get rights and content

Section snippets

Key points

  • Strong emotional reactions are to be expected in patients admitted to cardiac critical care; only some of these are pathological.

  • Important psychiatric issues associated with heart disease include anger and hostility, anxiety, depression, delirium and neurocognitive disorders, psychotic disorders, and posttraumatic stress disorder.

  • All of these psychiatric issues affect and are affected by aspects of cardiac critical care. Heart surgery, transplantation, mechanical circulatory support, and

Psychological responses to critical care

This paper addresses the psychiatric aspects of heart disease and the cardiac aspects of psychiatric disease as they pertain in critical care. Because heart disease remains the leading cause of death in the United States, and affects about one-third of all adults over the age of 35, and many psychiatric disorders are associated with increased heart disease risk, it is inevitable that there is substantial comorbidity in cardiac critical care with psychiatric disorders.1, 2, 3, 4

It is important

Differential Diagnosis

The Diagnostic and Statistical Manual of Psychiatric Disorders, 5th edition,6 makes a distinction between primary psychiatric disorders and disorders owing to the direct effects on the brain of other illnesses, medications, other substances, and substance withdrawal. In the cardiac critical care setting, this implies that the differential diagnosis of mood, anxiety, and psychotic symptoms must include an evaluation of anemia, fluid and electrolyte balance, renal and hepatic function, blood

Cardiovascular effects of psychotropic drugs

Many psychiatric medications have cardiac side effects (Table 3).59 The text highlights a few points.

Antipsychotic drugs cause QT interval prolongation through inhibition of potassium channels that mediate ventricular myocyte repolarization. QT interval prolongation is associated with increased risk of torsades de pointes. In a recent large scale Swedish study, Danielsson and colleagues60 found the antipsychotic drugs associated with the highest risk of malignant arrhythmias were haloperidol,

Left Ventricular Assist Devices

The main psychiatric problems associated with left ventricular assist device treatment for heart failure are delirium, adjustment and mood disorders, and cognitive dysfunction.67 Patients with heart failure who require ventricular assist device therapy frequently have preexisting cognitive impairment. Stroke after ventricular assist device placement is not infrequent, may be debilitating, and can lead to depression and cognitive impairment. Living with a ventricular assist device requires

Summary

Strong emotional reactions are to be expected in patients admitted to cardiac critical care; only some of these are pathologic. Cardiac critical care and associated technologies such as mechanical ventilation, ventricular assist devices, and defibrillation, are associated with predictable psychiatric problems including anxiety, delirium, depression, and acute and PTSD. Many psychiatric problems in cardiac critical care occur as secondary complications of the medical status of the patient, which

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    This article is an update of an article previously published in Critical Care Clinics, Volume 24, Issue 4, October 2008.

    Disclosure: Supported in part by the Nathaniel Wharton Fund, New York NY. The author has no financial or commercial interests to disclose.

    Author Contributions: Dr P.A. Shapiro is solely responsible for all aspects of this article.

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