Feb. 24, 2020

Mind matters

Institute addressing the mental health needs of patients with implanted cardiac devices

In 2018, two weeks after receiving a cardiac defibrillator to treat his atrial fibrillation, David Hunt, 78, was doing spring cleanup in his yard. Spying some gravel lying in the grass, he let his shovel head rest against the ground and bent down to pick up the small rocks. 

At that moment, he felt a jolt rip through his body as his defibrillator shocked his heart back into rhythm. The sensation sent him staggering to his deck and calling for his wife.

 “I felt like it blew my head off,” says Hunt. “It went through my nose, ears and head.”

Although the shock likely saved his life, the physical trauma caused anxiety, heightened by the fact that there were no warning signs before the defibrillator went off. Ultimately, it changed Hunt’s life.

Fearing a repeat, he stopped doing some of the things he enjoyed, like gardening and using his truck and trailer, because he felt the risk of another shock was too high.  

“I started to evaluate the activities I enjoyed and think ‘I can’t do these things,’” he says. “It really affected my quality of life and my ability to enjoy life.”

Hunt’s experience is not uncommon. Vikas Kuriachan, a cardiologist and the medical director of cardiac implantable electronic devices in Calgary, says patients have described the shocks generated by their defibrillator device as feeling “similar to being kicked in the chest by a horse.”

The pain and unpredictable nature of the shock can cause mental health concerns, including anxiety, depression and even implantable cardioverter-defibrillator (ICD) shock syndrome, a type of post-traumatic stress disorder that is unique to people with devices.  

“It’s a big deal,” says Kuriachan, noting the Calgary team implants more than 1,200 devices each year, including around 350 defibrillators.

Dr. Vidya Raj is a psychiatrist who specializes in helping heart patients at the Hearts and Minds Clinic at South Health Campus, which is open to all cardiac patients and accessible through a referral by a practitioner in Cardiac Sciences.

Raj, who opened the Calgary clinic three years ago, says mental health concerns for cardiac patients can range from mild anxiety and depression to ICD shock syndrome. She notes all cardiac patients may struggle to come to terms with their life-threatening health concerns and the associated lifestyle changes. These problems with mental health can have a devastating impact. 

“Patients with mental health concerns are three times less likely to adhere with care recommendations,” said Raj, adding depressed and anxious patients often fail to adhere to their medication or make critical lifestyle changes, such as exercising and eating healthy. 

These concerns aren’t unique to patients with devices. According to Raj, about a third of patients who have a heart attack become depressed, making them twice as likely to die of a subsequent cardiac event within five years. 

Raj, who is married to a cardiologist, says the loss of a sense of control highly increases risk of anxiety and depression. She added it isn’t uncommon for ICD post traumatic stress disorder patients to become isolated.
“I see a lot of suffering,” she says. “At the worst stages, you want to stop going out, stop going on holidays and are afraid to drive. You get this avoidance phenomenon.”

Raj says timely, responsive mental health support can make a huge difference. Hunt agrees. 

Although he is more than happy with the care he received, he didn’t receive mental health support following his shock. After suffering for more than a year, he attended a presentation, hosted by the Libin Cardiovascular Institute, that changed his outlook. 

The event featured Dr. Samuel Sears, PhD, a US-based clinical psychologist and internationally recognized expert on the care of patients with ICD devices. 

“I had a lot of ‘aha’ moments while listening to Dr. Sam Sears’s presentation,” said Hunt, whose heart is now in rhythm.  

His biggest takeaway was that his ICD is more likely to be triggered by inactivity.  
Hunt now offers the following advice to other patients. “Continue living your life and do the things you enjoy doing,” he says. 

He also encourages patients to seek the help they need. “If I had heard this talk earlier, it would have made a world of difference,” says Hunt. 

For more information and access to Dr. Sam Sears’s presentation, visit https://live-libin.ucalgary.ca/community/patient-resources/coping-your-device.

Another helpful resource for ICD patients and their families and friends is the ICD patient support group, which meets at Foothills Medical Centre four to five times per year. 

For more information or to join, email Paul Mercer at mercerpaul@shaw.ca or by telephone  at 403.944.1248 and ask for Sandra or Allana.