Don't Be So Sure It's Pump Head
Depression after heart surgery or after a heart attack is common, treatable, and dangerous if unrecognized. And now it’s likely to be written off as “Pump Head.”
By DrRich
Why
is depression is so significant in cardiac patients?
Why is depression so common in cardiac
patients?
Zen and the art of diagnosing depression
What to do if you or your doctor think
you might have pump head
Summary
In February, 2001, an article in the New England Journal of Medicine made a big splash by documenting the frequency and persistence of mental deterioration following coronary artery bypass surgery. This post-operative cognitive deficit, which has long been called “pump head” by medical personnel, is manifested most commonly by mental sluggishness, personality changes, and memory problems. (Click here for a quick review of pump head.)
These same symptoms – sluggishness, personality changes, and difficulties with memory – are often prominent symptoms of depression. And depression is also very common following both bypass surgery and myocardial infarction (heart attack).
Now that the existence of pump head is widely recognized by both doctors and patients, it seems very likely that patients who actually have depression will be written off as having pump head. This would be a big mistake, for two reasons. First, depression (unlike pump head) is treatable. Second, in cardiac patients depression can be lethal if it is untreated. Thus, mistaking depression for pump head can be a fatal mistake.
Why is depression so significant in cardiac patients?
In patients with heart disease, depression is known to be a major risk factor for serious cardiac events and death. Consider the following facts:
- People who have depression are twice as likely to have heart attacks as people without depression.
- Up to 30% of patients experience significant depression after heart attacks.
- People who become depressed after a heart attack are significantly more likely to suffer subsequent heart attacks, and are significantly more likely to die in the first year after their heart attacks.
- 20% of patients suffer from depression after bypass surgery, and these patients are three times as likely to have subsequent serious heart problems in the year following surgery.
There are many reasons depression may be detrimental. Depression itself may directly affect heart disease in some way – possibly by modulating certain chemicals within the bloodstream – just as it seems to affect other diseases such as cancer. There is evidence that depressed patients don’t follow-up with their doctors when new symptoms occur, fail to accomplish important lifestyle changes, and fail to take their medication as prescribed. There is also evidence that patients with mental illness of any type are not referred for extensive cardiac testing as frequently as patients without mental illness. Whatever the reason, depression poses a real risk to life and limb for cardiac patients.
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