Did you know?

Some Statistics

? 1.3 million de Canadians report having heart disease

? Cardiovascular diseases are the second-leading cause of death in Canada

? Men are more likely than women to have heart disease (5.3 % vs. 4.2 %); though studies are now showing that HD may be misdiagnosed or under diagnosed in women

?Cardiac health and mental health…. Go hand in hand.











Did you know?

Nearly HALF (45%) of all people with heart disease feel sad or discouraged about the future, lose interest in their activities, become angry, or feel defective or worthless, especially at the beginning…..











Did you know?

Depression can look different in men than in women.

? Sometimes it is harder to detect.

? Less obvious sadness

? Lack of motivation or interest

? More irritability and anger

? More substance abuse

? More risky behaviours

? Loss of appetite; weight loss


? After a cardiac event, we hear men say things like:

? “I’m not the man I was…”

? “It feels like I’m letting everybody down…”

? “I feel weak…what’s happening?”

? “I can’t do the things I want to do anymore….”

? “I should be happy to be alive but I feel sad all of the time….”

? Sometimes these feelings become a Major Depression.


After a diagnosis of heart disease, 1 in 5 people will become anxious.

In our clinic we hear men say:

“I realize the danger now.”

“I have to be careful or I’ll have another heart attack!”

“The next one’s going to be the BIG ONE.”

“I think I feel something in my chest!”

“What’s going to happen to me and my family?”

“If I can’t work what am I going to do?”

Traumatic Reactions

Heart disease can be traumatic.

? Men with heart disease who come to see us say :

? “I can’t stop thinking about my heart attack: where I was, the ambulance, everybody running around at the hospital, it was awful!”

? “It’s like it keeps happening over and over again.…”

? “I think about my dad, who had a heart attack, all the time.”

? “I try to put it out of mind but it keeps coming back….”

? “Now I don’t like hospitals or white coats….” Some studies have found that 24% of people develop post-traumatic stress disorder (PTSD) after a cardiac event.











Direct Links

? Activation of the sympathetic nervous system (fight or flight response)

? Increased blood pressure (HTN)

? Disturbances in heart rhythm, leading to increased risk of ventricular arrhythmias, decreased blood flow, left ventricular hypertrophy, and heart attack

? Effect of the Hypothalamic-pituitary-adrenal axis (stress-response system) – keeps SNS on!

? Increased levels of cortisol

? Increased HTN

? Increased risk of a metabolic syndrome : glucose intolerance, hyperlipidemia, and visceral fat

? Increased diabetes

? Inflammatory and immune mechanisms

? Increased platelet reactivity (thrombus formation and arterial occlusion)

? Endothelial dysfunction

? Inflammatory pathways

? Increased levels of inflammatory markers consistently associated with poor cardiovascular outcomes and heart attack

Indirect Links

? Behavioural and lifestyle factors

? Increased risk of an unhealthy lifestyle

? tobacco and alcohol use

? Poor diet (increased caloric diet & vitamin deficiencies)

? Sedentary behavior, lower physical activity levels

? Less engaged in treatment

? Less likely to obtain medical attention (e.g., delay ER visit)

? Lower medication compliance

? Refusal, non-adherence, and drop out from cardiac rehab

Social Impact

Your health not only affects you, but the people around you too, especially your partner and your family.

? Communication and sexual problems are common.

? The people who love you want to help but they do not always know how.

? It helps to talk….


?MEN DO NOT LIKE TO TALK ABOUT THEIR HEALTH… Especially not their mental health!

?Silence can be bad for your health!

?Mental health problems that go untreated can make heart disease worse!

“The Boy Code”

? The “Boy Code” and the “Guy Code” often prevent people from talking about their emotional distress.

? The Boy Code: Young boys must be strong, independent, intelligent, and efficient.

? The Guy Code: Men should focus on problem- solving, performance, and strength rather than identifying and managing their emotions.

*** Society does not afford men much opportunity to learn how to identify and manage the emotions that all humans experience, especially when they have to cope with chronic stressors such as heart disease.

What helps ?


? Helps a man feel stronger as he faces the challenges caused by his health.

? Encourages health

? Direct effects

? Indirect effects

? Helps work through difficult experiences & memories

? Helps work through uncomfortable emotions

? Helps protect against mental health problems

? Helps prevent relapse and death

? Do as many pleasant activities as possible (even better when with friends and loved ones)

? Exercise

? Social activities

? Hobbies

? Personal interests (e.g., music, sports)


?NOT the same thing as “positive thinking”

?Do not avoid

? TALK about what’s happening


?Compassion for oneself.

? Avoid thinking, “I shouldn’t feel this way”.

? INSTEAD: “It’s OK for me to feel this way. We all have emotions”.

?Try to find some meaning in your heart disease.

? Recognize how heart disease has changed your life and your plans for the future.

? In addition to the challenges, are there any positives?

? New priorities?

? Changes made for the better?

? Am I a better person in some ways?


? SSRIs (antidepressants)

? May have a protective effect & reduce risk – lower cardiac readmissions and mortality

? May reduce platelet aggregation

? New Generation Antidepressants

? Not extensively or systematically studied in heart patients











Exercise Interventions

?As effective as antidepressants in a 16- week intervention

?Combination of CBT & exercise produces best results

?Attend cardiac rehab & engage in exercise!!












? “Mind Over Mood” (Greenberger & Padesky, 2016)

? “Coping with Stress Booklet” (HSF) https://www.heartandstroke.ca/-/media/pdffiles/canada/other/coping-with-stress-en.ashx

? “Mind the Heart Booklet” (Movember Foundation) https://www.mindtheheart.ca/

? Antidepressant skills workbook – free online, http://www.comh.ca/antidepressant-skills/adult/

And if this is not enough?

? One month later……

? You’ve tried these techniques BUT you still feel anxious, sad, or on edge… THERE IS HELP !


We need to treat the heart…and nurture the mind.

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