Coronary heart disease is one of the leading causes of death and disability in many countries. Individuals suffering from heart disease are confronted by problems that are as much physical as psychological. A heart attack is anxiety provoking and carries a number of meanings, involving loss of control over one’s life, loss of health, the threat of future problems and the risk of death. About 20% of patients deny having had a myocardial infarction. They do not deny the experience of their symptoms, but attribute them to other unrelated disorders or to a mistaken diagnosis (Bennett, 1993). Individuals who are in denial may be unrealistically optimistic. Denial is a natural reaction, in the short term, in response to acute stress. However, long-term denial is unhealthy since deniers may overlook potentially fatal symptoms.

Patients may also experience anger and often blame themselves since heart disease is thought to be, in part, preventable. Anger is a strong emotion that can be turned inward as depression or outward. Around 60% of individuals who have an infarction attribute it to stress, overwork, inappropriate diet, smoking or lack of exercise and direct their anger towards themselves or the person they believe to be responsible for their disease. Anger is part of the process in dealing with anxiety and it is linked to the distressing consequences of the illness. But it can be damaging in the long term.

Approximately half of patients having had an infarction report moderate to severe levels of anxiety. Anxious patients are usually demanding, very dependent and expect instant attention and care (Bennett, 1993). Owing to the sudden and unexpected onset of the illness, uncertainties related to the future some concerns may be exaggerated.

Patients may be likely to fantasise about disablement, never being able to work again, being unable to function as a spouse or parent and having thoughts of death. If patients do not receive the necessary information on their condition, it is likely that they will be highly distressed since some of their concerns may be completely unrealistic.

Initially, after their diagnosis, around 30% of patients experience symptoms of depression. However, this figure rises six months after discharge from hospital. This is due to the increasing awareness of the implications of the illness. In hospital, patients may be perceived as totally compliant, well-behaved and accepting treatment while in reality the latter may be feeling lonely, fatigued, sad, lethargic, discouraged about the future and foreseeing risks of future problems. Following discharge, depressed patients are less interested in controlling their illness.

The final stage is that of acceptance and coping with changes related to the disease. This process may involve lifestyle changes. The greatest challenge to adaptation resides in being able to live without the daily fear of recurrence. Research has shown that 34% of patients frequently think about the disease, one year after their heart attack. Patients suffering from heart disease experience various negative emotions. It is important for them to be able to express these feelings. Internalizing them may inhibit the process of recovery. After expressing negative emotions, there is often a resurgence of positive feelings.

Accordingly, the aim of psychological care is to enable patients to explore their emotions, to facilitate their adjustment to their new way of life and to reduce anxiety, depression, anger, denial. Their perceptions of control and personal responsibility are also enhanced so that they can make rational decisions about their treatment and gain control over their future lives.

Doreyya MOHUNGOO,</B>