Emotional and psychiatric issues in hypertrophic cardiomyopathy and other cardiac patients.

Hypertrophic cardiomyopathy (HCM) exposes young patients to the risk of sudden death. The risk of sudden death separates the young patient from his peers, but connects him more closely to his physician. The physician may have a powerful effect replacing uninformed fears with accurate knowledge, restoring hope, and helping the patient shift focus from the fear of dying to engaging in life and living with a medical illness. Depression and panic disorder are two psychiatric illnesses that are common in cardiac practices, cause significant morbidity and mortality, and may be overlooked and undertreated. Depression is a significant cardiac risk factor. Panic disorder may be confused with cardiac illness and complicate cardiac treatment. The cardiologist should recognize these illnesses and help patients who have them receive treatment for the psychiatric as well as the cardiac causes of their distress. There is a possibility that treating these psychiatric illnesses may actually improve cardiac outcome. Cardiac and psychotropic medications may have additive side effects or interact by altering drug metabolism. Many psychotropic medications cause orthostatic hypotension that may worsen obstructive HCM.