Impatto psico-emotivo della sindrome coronarica acuta

Background. Acute coronary syndromes can substantially disrupt the lives of our patients. However, patients' view of their illness is usually scarcely considered in routine medical practice. We aimed to investigate the psycho-emotional impact of acute coronary syndromes. Methods.We studied 30 patients with acute coronary syndrome, aged <70 years. Before discharge, each patient was interviewed by a psychologist using a semi-structured interview; data were collected in the form of verbal reports. Results. After learning that they had had a heart attack, 16 patients (53%) reported a feeling of fear linked to the idea of death, sometimes real despair; 7 patients (23%) showed a weak emotional response, 4 (13%) reacted with denial, and 3 responded evasively. During the interview, 17 patients (57%) reported events relating to family life and 9 (30%) to work; all these events were negative and related to suffering, conflict, and stress. When compared to pre-admission status, 30% of patients experienced negative psychological changes, such as a sense of fragility, uncertainty and a redefinition of self-image, while 50% reported no change. Surprisingly, 6 patients (20%) referred positive psychological changes. This positive restructuring was related to the patients' ability/need to change their lifestyle. This process entails a different vision of the past and the future, and is associated with a feeling of rebirth and physical wellbeing. Conclusions. The psycho-emotional effects of acute coronary syndromes may be immense, and may radically change the way the patient relates to himself and to the world. We often remain detached from these changes, and are sometimes even unaware of them.