Psych · Consultation-liaison psychiatry
Cardiac psychiatry
Also known as Post-MI depression · Depression after acute coronary syndrome · Cardiovascular psychiatry · Psychocardiology · Heart failure depression · ACS-PTSD
Exam-exhaustive fellowship topic on cardiac psychiatry — post-ACS and CHD depression and anxiety, bidirectional risk and prognosis, landmark trials (SADHART, ENRICHD, CREATE, MIND-IT, SADHART-CHF, UPBEAT, MOSAIC), ACS-PTSD, ICD distress, Takotsubo interface, QTc-aware psychopharmacology, collaborative care and cardiac rehab. FRANZCP-primary, globally tagged.
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Target exams
Red flags
- Chest pain, arrhythmia, acute heart failure, or shock — medical/cardiology emergency first
- Active suicidal ideation after ACS with means access or total treatment refusal risking secondary-prevention collapse
- Severe hyponatraemia or major bleeding on SSRI plus dual antiplatelet or anticoagulant therapy
- Starting TCA or high-dose citalopram without ECG/QTc review in recent ACS or low EF
- Heavy sedation as 'treatment' of rehab non-engagement — worsens delirium, falls, and recovery
- Major financial or high-risk consent during untreated severe depression or delirium without proper capacity process
Meet the patient
Day four after a STEMI. A 62-year-old man is refusing cardiac rehabilitation. He is polite about it. He says he is tired, that there is no point, and that his wife would manage.[2][18]
The cardiology registrar has written "low mood — understandable post-MI, no action". He is on dual antiplatelet therapy, his ejection fraction is 38 percent, and his QTc is 460 milliseconds.[1][8]
Three questions are live: is this depression or deconditioning?, is he safe tonight?, and what can you safely prescribe in this exact cardiac context? The third question is why cardiac psychiatry is its own topic.[1][8][18]
References18ShowHide
- [1]Lichtman JH, Bigger JT Jr, Blumenthal JA, et al. Depression and coronary heart disease: recommendations for screening, referral, and treatment: a science advisory from the American Heart Association Circulation, 2008.PMID 18824640
- [2]Lichtman JH, Froelicher ES, Blumenthal JA, et al. Depression as a risk factor for poor prognosis among patients with acute coronary syndrome: systematic review and recommendations: a scientific statement from the American Heart Association Circulation, 2014.PMID 24566200
- [3]Frasure-Smith N, Lespérance F, Talajic M Depression following myocardial infarction. Impact on 6-month survival JAMA, 1993.PMID 8411525
- [4]Frasure-Smith N, Lespérance F Depression and anxiety as predictors of 2-year cardiac events in patients with stable coronary artery disease Arch Gen Psychiatry, 2008.PMID 18180430
- [5]Barth J, Schumacher M, Herrmann-Lingen C Depression as a risk factor for mortality in patients with coronary heart disease: a meta-analysis Psychosom Med, 2004.PMID 15564343
- [6]Nicholson A, Kuper H, Hemingway H Depression as an aetiologic and prognostic factor in coronary heart disease: a meta-analysis of 6362 events among 146 538 participants in 54 observational studies Eur Heart J, 2006.PMID 17082208
- [7]Carney RM, Freedland KE Depression and coronary heart disease Nat Rev Cardiol, 2017.PMID 27853162
- [8]Glassman AH, O'Connor CM, Califf RM, et al. Sertraline treatment of major depression in patients with acute MI or unstable angina. JAMA, 2002.PMID 12169073
- [9]Berkman LF, Blumenthal J, Burg M, et al. Effects of treating depression and low perceived social support on clinical events after myocardial infarction: the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) Randomized Trial JAMA, 2003.PMID 12813116
- [10]Lespérance F, Frasure-Smith N, Koszycki D, et al. Effects of citalopram and interpersonal psychotherapy on depression in patients with coronary artery disease: the Canadian Cardiac Randomized Evaluation of Antidepressant and Psychotherapy Efficacy (CREATE) trial JAMA, 2007.PMID 17244833
- [11]O'Connor CM, Jiang W, Kuchibhatla M, et al. Safety and efficacy of sertraline for depression in patients with heart failure: results of the SADHART-CHF (Sertraline Against Depression and Heart Disease in Chronic Heart Failure) trial J Am Coll Cardiol, 2010.PMID 20723799
- [12]van Melle JP, de Jonge P, Honig A, et al. Effects of antidepressant treatment following myocardial infarction Br J Psychiatry, 2007.PMID 17541103
- [13]Honig A, Kuyper AM, Schene AH, et al. Treatment of post-myocardial infarction depressive disorder: a randomized, placebo-controlled trial with mirtazapine Psychosom Med, 2007.PMID 17846258
- [14]Huffman JC, Mastromauro CA, Beach SR, et al. Collaborative care for depression and anxiety disorders in patients with recent cardiac events: the Management of Sadness and Anxiety in Cardiology (MOSAIC) randomized clinical trial JAMA Intern Med, 2014.PMID 24733277
- [15]Blumenthal JA, Sherwood A, Babyak MA, et al. Exercise and pharmacological treatment of depressive symptoms in patients with coronary heart disease: results from the UPBEAT (Understanding the Prognostic Benefits of Exercise and Antidepressant Therapy) study J Am Coll Cardiol, 2012.PMID 22858387
- [16]Templin C, Ghadri JR, Diekmann J, et al. Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy N Engl J Med, 2015.PMID 26332547
- [17]Edmondson D, Richardson S, Falzon L, et al. Posttraumatic stress disorder prevalence and risk of recurrence in acute coronary syndrome patients: a meta-analytic review PLoS One, 2012.PMID 22745687
- [18]Whooley MA Depression and cardiovascular disease: healing the broken-hearted JAMA, 2006.PMID 16804154