Transcript Slide 1

Living and Loving Life:
After Cardiac Arrest
Eva R. Serber, Ph.D.
Division of Bio-Behavioral Medicine
Department of Psychiatry and Behavioral Sciences
Medical University of South Carolina
Disclosures
Medtronic, Inc – Speaker Honoraria (2010)
© 2011 Serber
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FULL participation in a FULL life
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Survivors living not simply
surviving
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Today’s discussion:
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Resiliency
Behavioral Health
Prevention of poor adjustment
Emotions and cardiovascular disease
What to look for in yourself and loved ones
Ways to improve mood and return to life
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The Initial Reaction
• Gratitude
• Surprised and confused
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“Why me?” “How could this happen?”
Clean bill of health
Pinnacle of my [career, sport]
Peak fitness
Top of my game
• Sense of loss
– Functioning/activities
– Independence
• Anger / Sadness
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Your sentiments:
“I thank God”
“live life”
“blessed”
“empowerment”
“appreciate relationships”
“new life / second chance”
“reinvent myself”
“embracing life”
“changed my outlook”
“pay it forward”
“return to [life]”
“gratitude”
“advocate for change”
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Resiliency
• The ability to recover quickly from illness, change,
or misfortune
• Being able to “bounce back”
• The process of adapting well
• Involves behaviors, thoughts, and actions that can
be learned
• Is not without difficulty or distress
American Psychological Association, 2010;
The American Heritage® Dictionary, Fourth Edition, rev 2009.
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Living with Resiliency
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Benefit-finding / Posttraumatic growth
Faith
Social Support
Positivity and optimism
Humor
Flexibility
Setting Goals
Hope
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Resilience Factors & Health
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 risk of coronary heart disease
 cardiovascular events
 mortality
 rehospitalization after CABG
 CVD progression
 recovery from event
 mental health and social functioning
 general health
Cohen & Pressman, 2006; Giltay et al., 2006; Kubzansky et al., 2001;
Middleton & Byrd, 1996; Scheier et al., 1989, 1999; Sears, Serber, et al., 2004;
Tindle et al., 2009
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Cardiac Health is Behavioral Health
• Minimize stress
• Work less hours
• Stop smoking
– & abusing other substances
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Physical activity
Eating healthy
Watching your weight
Enjoying life
Adequate sleep
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Post-SCA Concerns
• Vulnerability & mortality
– Vs. new lease on life
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Search for coherence
Search for meaning
Identity
Control
Acceptance
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ICD-Specific Concerns
• Dependence on the box
– life-threatening vs. life-saving
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Device function and malfunctioning
Shock
Daily functioning
Body Image
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How will shock affect me?
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“Swift kick in the chest”
Rated as a “6” on a 0 - 10 pain scale.
ICD shock is often the primary culprit to poor QOL
Anxiety or depression ~ 13-38%
Avoidance
Hypervigilance
No changes
Sears et al., 2005
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The Struggle (Growth vs. Stress)
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Mental recovery alongside physical recovery
Appreciation vs. apprehension
Return to occupational and recreational activities
Fear and avoidance of activities
Rose or grey colored glasses
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What does surviving a cardiac
arrest mean to you?
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Coping Strategies
DO –
• Keep doing what you love doing
• Set (new) goals and accomplish them
• Unless otherwise directed, you do not need to
change how you enjoy living life
• Engage in heart healthy behaviors
– Physical activity – good for body and mind
– Eat right
– Relax and rest
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Coping Strategies
EDUCATE YOURSELF
• Knowledge is power!
– Disease state and “normal” progression
– About your ICD and how it works
– How to respond to a cardiac event /shock
• Seek information:
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Health care providers
Mental health/behavioral professionals
Other SCA survivors
Support group
– www.icdsupportgroup.org
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Coping Strategies
BE PREPARED –
• Keep the following information with you at all
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ICD Identification card
Medical jewelry
Current list of medications/allergies
Physician’s name and phone number
This information will help health care providers
take care of you in an emergency.
Sears et al., 2005
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Shock Plan
• Action plan with your physicians and family to
prepare for an ICD shock
– Write it down and spread the word!
• What to do medically
– When to call in or receive medical care
• What to do psychologically
– Stay or find calm:
• Breathe, talk, surround self with loved ones, carry on with
activities
• Carry it with you
Sears et al., 2005
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Goals of Care – for the Patient
• Be cured
• Live longer
• Improve or maintain function/ quality of life/
independence
• Be comfortable
• Achieve life goals
• Provide support for family/ caregiver
You are your best advocate!
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Kaldjian et al., Am J Hosp Palliat Care 2009;25:501-511
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Why is your emotional health so
important?
Not only for your well-being, but also
your health
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Negative Emotion, Distress, & CVD
• Poor self-care and health behaviors
• Cardiac events
– Ischemia
– Infarction
– Arrhythmias and cardiac arrest
• Provoke 20% of life-threatening arrhythmias or SCD
• Provoke ischemia in 50% of chronic IHD
Ahern et al., 1990; Burg et al., 1993; Dimsdale, 2008; Dunbar et al., 2001; Jain,
2008; Lampert et al., 2002; Lampert et al., 2009; Mittleman et al., 1995;
Muller et al., 1999; Ramachandruni et al., 2006; Rozanski & Blumenthal,
2005; Shedd et al., 2004; Smith & Ruiz, 2002; Ziegelstein, 2007
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This is to encourage you to hold onto
what is good
“The future’s so bright, [you] gotta wear shades.”
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If you start to struggle, you may feel
like this:
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Feeling depressed, down, “blah,” or hopeless
 interest, pleasure in enjoyable activities
 motivation to engage in activities
Feeling “wound up,” nervous, on edge, or
worrying a lot
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Other symptoms of distress are
physical:
• Difficult to distinguish from cardiac symptoms:
–  heart rate
–  respiratory rate
– SOB
– Fatigue
– Change in sleep
– Chest pain
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Distress also affects what you do:
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Avoid activities
Avoid people
Reduced self-care
Change in eating/ appetite
Change in sleep
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Stress-Management Techniques
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Diaphragmatic / Belly Breathing
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Guided Imagery
• Take yourself to a peaceful, safe place (place you
know or imagine)
• Activate all 5 senses: sight, smell, taste, touch,
hear
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Thought Management
• Identify automatic negative thoughts
• Identify alternatives to those negative thoughts
• Challenge and replace negative thoughts
• Find a “positive”
– In the situation or another area of your life
– Blessings, affirmations, accomplishments
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Know When to Get Help
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Change in mood or temperament
Change in sleep
Change in appetite
Low tolerance for people or activities
Feel confused, lost, helpless, hopeless
“Can’t be bothered” to take care of yourself
Reduced interest in activities you usually enjoy
When your own strategies aren’t working…
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Referral Sources
• Cardiac Psychologist/specialization in
cardiovascular behavioral medicine
• Health Psychologist
• Behavioral Medicine Clinic
• Consultation/Liaison Psychiatry Service
• Psychiatric Nurse
• Behavioral Health Provider
• Clinical Social Worker
• Chaplain/Spiritual Leader
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Resources
• SCAA.org
• American Psychological Association / American
Psychiatric Association
• Local Psychological Association
• Device manufacturer’s written and online
materials
• Heart Rhythm Society
• American Heart Association
• SAMHSA
• NIH: NIMH or NHLBI
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What to look for when choosing a
clinician
• State license to practice
• Your health insurance approved providers
• Experience in working with medical illness
– Better yet with cardiac conditions (bonus)
• Therapeutic approach
– Cognitive and Behavioral Therapies backed by research
• Your comfort level
© 2010
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Resources
• SCAA.org
• American Psychological Association / American
Psychiatric Association
• Local Psychological Association
• Device manufacturer’s written and online
materials
• Heart Rhythm Society
• American Heart Association
• SAMHSA
• NIH: NIMH or NHLBI
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Benefits of Psychological/ Behavioral
Interventions
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 psychological well-being and QOL
 exercise capacity and physical fitness
 physiology
 physical symptoms
Chevalier et al., 2006; Fitchett et al., 2003; Frizelle et al., 2004;
Pedersen et al., 2007; Sears et al., 2009
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Thank you
Questions?
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