Impact of Cardiac Disease on the Patient

Patients with cardiac disease are intensely fearful. Once cardiac disease has been diagnosed, a series of reactions occurs. Fear, depression, and anxiety are the outcomes. The patients, who were totally asymptomatic until their episode of ''sudden death'' resulting from a coronary occlusion, are scared. They were resuscitated the first time;will an episode happen again? When? During recovery in the hospital, they are afraid to leave the intensive care unit for fear that ''no one will be watching.'' At the time of discharge from the hospital, they are filled with anxiety. Although they desperately want to go home, they ask themselves, ''What will happen if I have chest pain at home? Who will provide medical assistance?'' They go through a period of depression, recognizing what they have gone through. After convalescence, they become fearful of daily situations that may provoke another attack. Can they go back to the daily ''hassles'' at work? Is it safe to have sexual intercourse? Despite appropriate reassurances from the clinician, their anxiety level may remain high.

Many patients with cardiac disease who have witnessed a fatal cardiac arrest in another patient in their room refuse to admit how stressful this event really was. The patients freely discuss the efficiency of the cardiac arrest team or complain that the noise kept them from sleeping. They refuse to identify with the deceased patient.

The patient with cardiac disease approaching surgery has the same fears as all surgical patients;these fears are discussed in Chapter 2, The Patient's Responses. However, surgical procedures for the patient with cardiac disease involve the ''nucleus'' of the body. The conscientious clinician takes time to explain the nature of the problem and the surgical approach. Before the procedure, the clinician should allow the patient, and especially the family, to visit the intensive care unit where the patient will be for a few days after surgery. Patients should be reassured that everything possible will be done in their behalf. Their courage and determination and the clinician's support are essential.

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