Depression After Heart Attack
Muhammad Usman Naeem, Abdul Ghani MD
Depression
Depression is not understood, underdiagnosed, and undertreated. Most depressed patients look fine, but they have high levels of stress chemicals (cortisol, epinephrine, and angiotensin) that keep the heart rate around 90-100, instead of at 60-70.Stress chemicals will direct extra weight to the belly, the most dangerous storage area for fat. Trust me, it is complicated. A happy person with extra weight will deposit fat in the upper body or legs, the less dangerous storage areas. Belly fat produces many dangerous inflammatory chemicals that cause HTN, DM, heart disease, etc., then fat in other areas does.
Inflammation of the brain causes depression and anger. In the brain that has more omega 6 fat than omega 3 fat, the brain cells become stiff; they are not well connected. That causes a chemical imbalance which leads to anxiety and depression.
The depressed person is more prone to having heart disease. He is not motivated to follow a healthy diet or exercise.
Depression is more common in heart disease. There is a high incidence of heart failure in depressed folks. A two-year death rate after a heart attack is high in depressed folks. This happens because of a faster heart rate which causes extra work for the heart and weakening the heart. A faster heart rate in heart failure is more likely to cause an irregular heart rate. The faster the heart rate, the higher the mortality rate. The slower the heart rate, the less likelihood of an irregular heart rate and the lower the mortality rate.
What to Do
- Screen every person for depression, especially those who are obese with chronic pain, DM, HTN, and high cholesterol.
- Eat healthy food. Reduce inflammation.
- Exercise will reduce the fat in the belly, fat in the blood, burn fat, increase HDL cholesterol, and reduce the risk of a heart attack/ subsequent heart attack.
- Exercise will reduce inflammation by reducing TNFa and CRP and increasing interleukin 4 and interleukin 10
- Exercise will switch SNS with epinephrine to PSNS and stimulate the vagus nerve, reducing the risk of arrhythmia and death.
Walking and eating healthy food, especially food with omega-3 fats, will reduce depression and
make antidepressants more successful.
The way arteries (carrying clean blood from the heart to arms and legs) and veins (carrying unclean blood from arms and legs to the heart) are laid in muscles. With exercise, the working muscles compress the arteries (so blood moves easier to arms and legs) and compress the veins (so blood moves easier from arms and legs to heart).
Exercise assists with the pumping function of the heart and the filling function of the heart. Additionally, exercise makes the heart strong (increases the ejection fraction of a weaker heart.)
The way arteries (carrying clean blood from the heart to arms and legs) and veins (carrying unclean blood from arms and legs to the heart) are laid in muscles. With exercise, the working muscles compress the arteries (so blood moves easier to arms and legs) and compress the veins (so blood moves easier from arms and legs to heart).
Exercise assists with the pumping function of the heart and the filling function of the heart. Additionally, exercise makes the heart strong (increases the ejection fraction of a weaker heart.)
Care after the Heart Attack
The patient is in intensive care. He is either ignoring his feelings or worried about everything, e.g. job, bills, and family. Underlying depression anxiety surfaces. Medically, every heart attack ends up in heart failure if the patient lives long enough.What Can Be Done
- Every patient should be screened for anxiety and depression. There are effective and safe drugs to treat them.
- Treat the mother disease. The patient with a heart attack had plaque buildup since the age of 20, not only in the coronaries but in heart attack or stroke. Plaque buildup should not just be stopped; it needs to be regressed.
- Remove the inflammation. The patient should be consuming a healthy (anti-inflammatory) diet. Eat more Omega 3 fat and less Omega 6.
- The patient should take ASA/Plavix to reduce the stickiness of the platelets.
- The patient should walk when he is allowed by the doctor, either first in cardiac rehab or gradually around the house. The patient could even use a treadmill.
- The patient should take a statin at bedtime and fenofibrate (90-160 mg) in the morning. If the doctor says he has fixed one artery (90% clogged) with a stent the other one is only 30% clogged, that 30% clogged, he is talking about blood flow. The next heart attack could come from plaque in the artery, which is only 30% clogged, or from plaque 2 cm away from a stent.
- The patient could have a heart attack or a stroke because of too high LDL and low HDL. With walking and the use of statin, HDL will increase. The HDL of 55 cleans the arteries everywhere; that is called regression.
Walking and Exercise
Adiponectin (produced from fat cells) and resolvins (from Omega 3 fat) remove scar tissue from the heart muscle and activate inactive stem cells.This creates new blood vessels, makes the heart muscle stronger, and prevents heart failure. There is a high risk of arterial fibrillation (irregular heart rhythm) because of the scar tissue. Fish should be eaten 2-3 times a week and fish oil (Omega 3) should be taken by capsules 1-2 grams a day. This will prevent irregular heart rhythm and should be started right after a heart attack,
Walking switches the sympathetic nervous system from a fast heart rate (pro-inflammatory) to the parasympathetic nervous system. The parasympathetic nervous system slows the heart rate through the vagus nerve; it is anti-inflammatory. The faster the heart rate, the more the likelihood of an irregular heart rhythm and thus a higher mortality rate. The slower the heart rate, the less likely it is to have an irregular heart rhythm and thus a lower mortality rate.
With an ASA, a statin, walking, and fenofibrate, a person can heal the heart, clean the arteries, regulate the heart’s rhythm, and prevent heart failure.
Yoga
Deep slow breathing and mindful meditation also switch the sympathetic nervous system (fast heart rate and nervousness) to the parasympathetic nervous system (anti-inflammatory, calming, and slowing the heart rate).
Do not rush into retirement. Take 3-6 months leave without pay.
Go through cardiac rehab for 12 weeks and then continue to walk and eat healthy food. Cardiac rehab will give you time to think to get your priorities straight, and not to fall victim to family dynamics.
Go through cardiac rehab for 12 weeks and then continue to walk and eat healthy food. Cardiac rehab will give you time to think to get your priorities straight, and not to fall victim to family dynamics.
Citation list
- ENDO, A. (2010). A historical perspective on the discovery of Statins. Proceedings of the Japan Academy, Series B, 86(5), 484–493. https://doi.org/10.2183/pjab.86.484
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Written By
Abdul Ghani
Dr. Abdul Ghani is an endocrinologist in Zephyrhills, Florida. He earned his medical degree from King Edward Medical University and completed his Internal Medicine residency at Cook County Hospital in Chicago, Illinois. With over 40 years of practice, Dr. Ghani specializes in treating chronic diabetes, hypertension, obesity, and hyperlipidemia. An avid reader, he possesses a thorough understanding of human diet and the benefits of exercise.
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