Regaining control: the process of adjustment after myocardial infarction

Article Abstract:

Although considerable attention has been paid to the process of rehabilitation following a myocardial infarction (MI, heart attack) there has been little given to the period of psychologic adjustment. The importance of the patients' perceptions of their own recovery process is explored. Confounding the literature is the notion that MI is predominantly a male disease, in spite of the fact that women compose a large percentage of individuals who have MIs. The psychologic healing process was examined in seven men and seven women. The study was carried out in 26 unstructured interactive interviews, each of which lasted between 60 and 90 minutes. The subjects were selected from either a self-help group or from among participants in a coronary rehabilitation program. Although the results suggest that the process is highly variable, four distinct psychologic stages emerged as the individuals strove for regaining their sense of personal control over their lives. The stages include: defending oneself; coming to terms with the illness; learning to live; and living again. The role of a patient's own perceptions in the process of healing is stressed. Surprisingly, many individuals in this study expressed shame or guilt at having had an MI, which may indicate that they, as victims, are being blamed for their disease. Perhaps this is a consequence of the fact that in our health-conscious society, disease itself is stigmatized. The data also suggest that individuals' perceptions of their disease change with time and consequently their behavior and responses also change. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Adjustment (Psychology)

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Marital functioning after cardiac surgery

Article Abstract:

A heart attack is a life-threatening event that results from a decrease in blood flow to the heart, and afterward often drastically changes a patient's relationship with a spouse. The heart attack patient is frequently isolated from the worries of the outside world, but the spouse often has to deal with both home and work responsibilities. The patient's spouse is often angry, frustrated, and resentful because of the unclear responsibilities he or she faces during the patient's recuperative period. The spouse may use a variety of coping mechanisms, but often suffers from anxiety and depression, fearing that the patient will have another heart attack, especially if sexual activity is resumed. Worries concerning the financial status of the couple also prevail. A recent study of 136 patients who were operated on for heart disease were examined with their spouses to assess the extent of the spouse's anxiety; how the spouse coped with problems; how the couple complied with directions for follow-up care; and how the couple related to each other. Couples that functioned very well in the recuperative phase were characterized by low anxiety of the spouse. Additionally, those couples that confronted their problems and engaged in positive constructive interactions had a easier time dealing with the recuperative period. Since spouse anxiety directly relates to how well the couple will function after a heart attack, it is suggested that the spouse be included in the patient's rehabilitation program and receive counseling on how to cope with the patient's condition. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Surgery, Myocardial revascularization, Heart, Communication in marriage, Marital communication, Heart surgery

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Return to work after an acute myocardial infarction: a review

Article Abstract:

Following a severe heart attack (acute myocardial infarction or AMI), individuals frequently change their work patterns. These changes are serious enough to constitute a significant component of the disease process. The scale and economic consequences of AMI are large; 320,000 AMI patients are discharged yearly from nonfederal acute care hospitals alone. The cost to society is in the billions of dollars, a cost which is made up in part by the changed working patterns of the victims of this disease. Approximately 90 percent of patients with their first heart attack return to work approximately 2 months following the attack; however, only 70 percent remain at work by the end of the first year. In addition, many patients decrease the amount work they do and change its quality. The pattern of which workers are likely to return to work and factors that contribute to the probable outcome of AMI patients are explored. Psychosocial factors appear to be more important than physical ones in determining the willingness or ability of a patient to continue working. To some measure this may be tied to job satisfaction, or to gender-based self image. Men in white color jobs who can rely upon a competent and supportive family support system are more likely to resume their previous work roles than either women or men in blue collar jobs. (Consumer Summary produced by Reliance Medical Information, Inc.)

Employment, Job satisfaction, Quality of work life

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