Psychiatric disturbances in patients undergoing open-heart surgery

Virtual Reality for Pain and Anxiety Management in Cardiac Surgery and Interventional Cardiology

Pain and anxiety are common in patients undergoing cardiac surgery and percutaneous cardiac interventions. Virtual reality (VR) is an emerging non-pharmacological tool for pain and anxiety management. However, its application around cardiac procedures remains relatively unexplored. In this review, we perform a targeted non-systematic literature review to assess the current state-of-the-art of VR for pain and anxiety management in patients undergoing cardiac procedures. Contexts of interest were preprocedural, periprocedural, and postprocedural applications. Existing trials show inconsistent results. The majority of studies in the preprocedural (7 studies, n = 302), periprocedural (1 study, n = 99), and postprocedural stage (4 studies, n = 214) demonstrate significant reduction of pain and anxiety through VR distraction therapy or VR patient education. However, larger-scale trials (2 preprocedural studies [n = 233], 1 periprocedural study [n = 32], 2 postprocedural studies [n = 300]) report no effect. Current literature on effectiveness of VR for pain and anxiety management in cardiac surgery and interventional cardiology remains inconclusive.

Cardiac rehabilitation for elderly, weak patients who undergo transcatheter edge-to-edge repair: a case report

Background

The positive role of rehabilitation programmes for some cardiac patient populations (e.g. coronary artery disease, heart failure, transcatheter aortic valve replacement, and heart transplantation) is now well-known. However, the feasibility and outcomes of rehabilitation, prior to or immediately after percutaneous mitral valve reconstruction, using a clamping procedure have been poorly reported, especially among frail elderly patients.

Case summary

An 85-year-old woman with acute heart failure symptoms (New York Heart Association functional class III), who had acute myocardial infarction 3 months ago, was hospitalized. An ultrasound cardiogram showed severe mitral regurgitation, and after a multidisciplinary discussion, transcatheter edge-to-edge repair (TEER) was considered the safest treatment option. Even then, though, due to her poor health status, it was still too risky for the patient to undergo without significant prior preparation. Thus, we decided to begin pre- and post-surgery cardiac rehabilitation (CR) to prepare her for TEER, comprising medicinal, nutritional, and psychological support, as well as exercise and smoking cessation. After pre-operative assessment and rehabilitation, the patient underwent TEER, followed by post-operative reassessment, and continued rehabilitation.

Discussion

Our case study demonstrates that CR, both pre- and post-TEER, aids in improving the conditions of elderly patients with poor health, to minimize their risk for developing TEER-related complications. This case provides one possible CR regimen for those patients.

The role of the lived body during the integration of the traumatic experience of the sternotomy scar: A case study

BACKGROUND

Open heart surgery is a potentially traumatic experience for patients, thus posing a real risk to both the patient's physical and mental health as well as bodily integrity. All of these can greatly affect the emotional relationship to the sternotomy scar, the physical aspect of self-representation. Sternotomy scars mark patients for life, yet our knowledge of patients' subjective experiences is unknown.

METHOD

In our case study, we explore the embodied experiences of a woman (42) who underwent open heart surgery with the method of interpretative phenomenological analysis combined with drawings.

RESULTS

The body and the bodily experiences play a prominent role in the formation, healing process, and symbolism of a scar. The central core of the traumatic experience of open heart surgery is the attack against the patient's sensation of bodily integrity. The interviewee experiences the surgery as abuse committed on her body, a memory that is deeply etched both in the physical memory and in the form of a scar on the skin.

CONCLUSION

Based on our study, it seems that the corporeal dimension of posttraumatic growth may develop after the traumatic experience of heart surgery, in which bodily intimacy with oneself and Significant Others plays a major role. In this case study, the objective reality of the heart as "sick" flesh and the "broken, pierced" bone (Körper), as well as the dissociation-and then its integration-of the lived, living body experience (Leib) are outlined. Our case study was analysed in the theoretical framework of phenomenology and psychoanalysis.

Psychiatric symptoms in patients with non-valvular atrial fibrillation

Background

Atrial fibrillation (AF) is one of the leading causes of hospitalization and even death worldwide. Complex bidirectional associations have been suggested between psychiatric disorders and AF disease. This study was conducted to investigate the prevalence of psychiatric symptoms in a cohort of Egyptian population presented with symptomatic non-valvular AF (NVAF) and to identify the high-risk subjects in need for professional psychiatric consultation. A total of 100 eligible symptomatic NVAF patients were recruited in this cross-sectional study. Each patient was subjected to: (1) cardiac evaluation included electrocardiogram, trans-esophageal echocardiography, and the European Heart Rhythm Association (EHRA). (2) Psychiatric evaluation consisted of clinical psychiatric interviewing, Hospital Anxiety and Depression Scales (HADS), Mini–Mental State Examination (MMSE), type-D personality screening, and the short form-36 (SF-36) health survey for the assessment of health-related quality of life (HRQoL).

Results

Forty-four percent of our enrolled AF patients had anxiety symptoms, 32% had depressive symptoms, 24% had mild cognitive impairment, and 32% had type-D personality. Linear regression analysis demonstrated that the left atrial dimension (LAD) and the age were the main significant predictors of MMSE, while the main predictors of HADS were SF-36 (physical functioning and general health) and the age. Neither psychiatric symptoms, nor type-D personality was a significant predictor for the evaluated cardiac parameters.

Conclusions

Mild cognitive impairment as well as depressive and anxiety symptoms is not uncommon associates with NVAF patients. Assessment of cognitive function and HRQoL is strongly advised for AF patients presented with enlarged LAD particularly among old adults.

Impact of educational programme on patient's health outcomes following open heart surgeries

BACKGROUND

Postcardiac surgery, numerous factors have been shown to predict postoperative harm of QoL, such as age, female sex, history of hypertension, chronic obstructive pulmonary disease, education level, marital status, and also psychological factors such as the presence of mood disorders. So, the essential key to self-management is behavioural change, which is necessary to improve the quality of life of patients and Health outcomes.

AIM

The aim of this study is to evaluate the impact of the education programme on patients' health outcomes following open heart surgeries.

PATIENTS AND METHODS

Quasi-experimental research design carried out in intensive care for open heart surgery in Suez Canal university hospitals at Ismailia Governate on all available both sex patients performing open heart surgery for 6-month period (60) using the following four tools: the first tool for patient's risk stratification model Euro Scale sheet; the second tool New York Heart Association scale for assessing functional abilities; the third tool for health outcomes sheet for assessing patient's quality of life and health status; and the fourth tool for assessing Hospital Anxiety and Depression Scale.

RESULTS

There was no significant difference found in the patient's vital signs before and after the educational programme. On the other hand, there was no statistically significant difference between overall quality of life and socio-demographic characteristics before and after the educational programme.

CONCLUSION

This study concluded that the educational programme has a positive effect on patients' quality of life in patients' educational programme; improve patient's health status as indicated by improved patient outcomes.

RELEVANCE TO CLINICAL PRACTICE

The most important finding was the value of the educational training programme to address the needs of open heart surgery patients, indicating that after heart surgery, patient education by training can be helpful in self-care, and nurses can use a programme containing preparatory information to enhance results, alleviate patients problems, and improve the quality of life in patients with CABG.

The Psychological and Somatic Consequences of Digital Amputation

Major limb amputation is a devastating potential outcome of trauma, tumor, or disease. Much has been written about the physical, functional, economic, and psychological consequences of major limb loss. In contradistinction, considerably less has been written concerning the consequences of "minor" limb loss, specifically single partial digit amputations. Are minor limb (partial single digit) amputations associated with symptoms of psychological disorder similar to those reported for major limb amputations?

Methods

We conducted a clinical research study through interview and examination of 25 adult patients (average age: 45 years) who had suffered a single partial digit amputation to determine if symptoms of depression, anxiety, anger, or posttraumatic stress disorder newly occurred, and if such symptoms correlated with the surgical outcome. Questionnaires for Quick-DASH, Michigan Hand Score, and Diagnostic and Statistical Manual of Mental Disorders-5 Psychological Profile testing were completed.

Results

All but one of the patients suffered from psychological symptoms for a minimum of 3 months. Symptom resolution time averaged 6 months for seven of the 25 patients. For 18 of the 25 patients, both psychological disturbance and neuroma pain were ongoing. The Psychological Profile scores suggesting pathology were inversely related to the scores on the Quick-Dash and Michigan Hand (somatic) questionnaires indicating wellness (P < 0.03).

Conclusions

(1) Even minor partial amputations of single digits can trigger significant psychological disturbance; the study hypothesis is validated. (2) Psychological and somatic outcomes are directly correlative. (3) Mitigating neuroma pain and verbally offering psychological support services early in the postamputation period should improve the clinical outcome of digital amputations.

Prevalence and Predictors of Suicidal Ideation in Patients Following Cardiac Surgery

BACKGROUND

Patient-reported outcomes (PROs) which demand special attention and immediate help are referred to as PROs alert. Suicidal ideation (SI) is one of the PROs alerts which are insufficiently investigated. The aim was to assess the prevalence and risk factors for SI in patients following cardiac surgery.

METHODS

A total of 190 patients (mean age: 66.09, SD = 10.19; 57 women) were assessed at three months following cardiac surgery. SI was identified using the Patient Health Qustionnaire-9 (PHQ-9) question. The Hospital Anxiety and Depression Scale-Modified was used to assess anxiety, depression, and irritability. Additionally, self-perceived health improvement and level of hope were assessed using the Likert scale. Dyspnea and chest pain were assessed using a visual analogue scale.

RESULTS

SI was observed in 14.7% of participants. Patients experiencing SI had significantly higher levels of depression, anxiety, irritability, dyspnea and chest pain. They perceived the surgery to be less effective and had lower levels of hope. No significant relationships were found regarding age, sex, employment status, myocardial infarction, heart failure, operation mode, type of procedure, extracorporal circulation, hospital stay and postsurgical complications. Logistic regression revealed female sex (B = 2.363), higher anxiety level (B = 0.451) and older age (B = 0.062) to be risk factors for SI. The total variance explained by the model was 46%.

CONCLUSIONS

Assessing suicidality and negative emotions with special emphasis on anxiety simultaneously with somatic complaints is vital to address PROs alerts and improve care for patients following cardiac surgery. In-depth evaluation and psychological care are recommended in case of positive screening.