Just had heart surgery? You might get the blues

Before his heart attack, Cyril Hennequin, 67, was an avid cyclist who would ride over 60 miles around his neighborhood in Victoria, Australia, on a typical Sunday. The heart attack, which happened in 2015, was most likely triggered by stress, doctors said, but Hennequin struggled to accept his new reality.

“After leaving the hospital, and for the first few weeks and months, I was not angry, just very annoyed and sad,” Hennequin said in an email. “The emotional roller coaster followed as shock and denial to accept that this has happened to me.”

Research from Australia by psychological scientist Dr. Barbara Murphy has found that most patients who go through an acute cardiac event, like a heart attack or surgery, experience the “cardiac blues.” The term, which Murphy and her colleagues coined in 2015, refers to a period of deep sadness or anxiety lasting up to four months after the event before resolving naturally.

It’s reasonable to expect that, after a major health event, patients might experience an emotional response, and similar responses have been noted in cancer patients and those diagnosed with chronic diseases, she says.

But researchers are still trying to unravel the specific connection between heart and mind.

Cardiac patients are at higher risk of conditions like depression and anxiety, while people with those mental health conditions are at higher risk for cardiological disease. “It’s a bidirectional relationship,” Murphy says.

Some studies have investigated a potential link between mental health and cardiac conditions through the C-reactive protein, which is a key marker of inflammation. Others have looked to the sympathetic neural system, which controls both heart rate and blood flow, and stress responses.

And, when it comes to the cardiac blues, a previous mental health diagnosis of anxiety or depression is often used as an indicator to predict whether a patient might recover during that four-month period or experience longer-lasting symptoms, Murphy says.

“If someone walks in the door and they’re in that older category, they haven’t had anxiety or depression in the past, they’re financially reasonably well off … they might be feeling really crappy and go through the cardiac blues, but chances are they’re not going to go on and develop anxiety or depression,” she says.

But cardiac patients aren’t necessarily informed about the emotional toll they can expect after discharge. In 2015, Murphy conducted a study with 160 cardiac patients admitted to two hospitals in Victoria, Australia. Of those, only one in three reported receiving any information about the emotional aspects of having a cardiac event. But about 75% of participants said that they wished a discussion about mental health had been part of their discharge process.

“We’ve done loads of surveys with patients, and they all told us that if they’d known they were going to go through this difficult period, it would have helped them in their adjustment phase,” Murphy says.

Giving that period a name, she says, is part of a larger effort to make conversations about mental health a more normal part of the discharge and recovery process. In the United States, both the conversations and the access to actual mental health treatment remain out of reach for many patients.

“We don’t necessarily have a term, or even terms, to refer to mental health consequences of cardiac experiences,” and many cardiologists feel unequipped to discuss mental health with their patients, says Dr. Jennifer Sumner, a clinical psychologist at the University of California, Los Angeles who researches how cardiac events might trigger symptoms of post-traumatic stress disorder.

Sumner says that in the U.S., most of the push toward improving access to mental health resources is directed at cardiac rehabilitation programs. But most patients don’t enroll in those programs: The American Heart Association reports that only one in four Medicare recipients participate in cardiac rehabilitation. And multiple studies have indicated that Black, Hispanic, and Asian patients are less likely to enroll in (or have access to) cardiac rehab than white patients.

That creates a gap in patients’ recovery process, Sumner says. It also creates a gap in the research on the relationship between cardiology and mental health. “If we treat these symptoms, does that relate to or translate into a better course of disease for patients?”

“I think something like ‘the cardiac blues’ … provides a terminology that maybe provides a little bit of a foothold,” Sumner says, adding that it could offer an easier way into a conversation about mental health for both cardiology providers and patients who might not have had it on their radar.

Cyril Hennequin didn’t learn about the cardiac blues during discharge, but he was lucky to enroll in a cardiac rehabilitation program where clinicians discussed the emotional toll of his experience.

“My heart attack was an emotional experience, not just a physical one,” he says, adding that he’s back on his bike and has added pilates and yoga to his exercise regimen.

For Murphy, giving people’s experiences a name is a first, important step to addressing the problem.

“It’s like going through a tunnel, but there’s no light at the end of it,” Murphy says, “whereas once you know what the cardiac blues is, you can see the light there the whole time.”

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Julia Vaz

About Julia Vaz

Julia Vaz is a science journalist whose work has appeared in AP News, The Washington Post, Inside Climate News and New Hampshire Public Radio.