Wellbeing

Mental health

Some SCAD patients struggle greatly with their mental health after SCAD. Many suffer with anxiety and panic for the first time in their life. Rest, loving support, healing and counselling can all help. For many, talking to friends or family, or engaging with the SCAD survivor community on Facebook is enough to provide the support they need but for others, it feels more serious. In this instance here is some advice and resources.

  • Talk to your Cardiac Rehab team if still doing rehab, as some rehab teams have links with psychological support, eg Cognitive Behavioural Therapy (CBT) to help patients manage stress and anxiety. Click here for NHS information on CBT.
  • Talk to your GP – for possible referral for counselling and/or medicinal support (sleeping tables, anti-depressants etc).
  • Self-refer to counselling
  • Research private counselling near to where you live. This can be expensive (£40 an hour or more in some areas) but there is generally little or no waiting list compared to what is available on the NHS.

Sorting out our heads after SCAD is key to physical recovery. It is hard to do one without the other!

This video by Dr Abi Al-Hussaini explains the mental well-being aspects of recovering after SCAD.

There are many ways that SCAD patients can find psychological support.  A presentation given at the 2016 Beat SCAD conference by Catherine Mulcaster, accredited counsellor/psychotherapist and coach, summarises them and you can click here to view the slides.

A key principle to good mental health is to try to ‘live in the moment’ instead of worrying about what the future might hold. This is easier said than done, of course!

Taking a holistic approach can help. Many SCAD patients find that investigating things like: yoga, pilates, mindfulness, breathing exercises, guided meditations etc all help them to manage stress and anxiety and live more ‘in the moment’ as they recover from their SCADs.

Sally Bee is a fellow SCAD survivor. She is a TV cook and nutritional therapist and has a subscription group called Being the best you, which many SCAD patients find useful. It includes tips on: healthy eating, weight loss and mental health support.

You can also watch our conference video where Sally explains Because it’s your heart, it plays with your head.

Hyper-vigilance and SCAD

Healing (often spasm-like) pains have been reported by 60-90% of SCAD patients in different research studies, particularly by people who have stents. Other physical causes of chest pain can be musculoskeletal because of changes in our posture.

Anxiety can become a feature of post-SCAD life for many, with every slight change in the body causing a ‘what was that?’ lurch in the pit of the stomach. With a mind on high alert, it is no surprise that a small change in the body can quickly cause a massive over-reaction by the nervous system.

Panic attacks can very easily mimic heart attacks. Some re-admissions to hospital after SCAD for chest pain that turn out to be a false alarm may be caused by anxiety. Some people talk to their GP and get medications to support them.

There are lots of other things to try too: learning how to ‘rest’ the brain is key to mental recovery. Click here for an example of a relaxation video. There are many other resources online, from breathing mindfully, learning ‘rectangular breathing‘, to practising mindfulness. It is very important to also prioritise sleep.

For more information about sleep:

NHS tips to beat insomnia

Headspace information on how to sleep better

Sleep Foundation sleeping tips

Mental Health sleeping better

At other times distraction can be a solution… jigsaws, craft activities, stroking a pet etc. Watching funny TV is great as well – laughter really is the best medicine.

Exercise after SCAD

Many SCAD survivors are told, initially at least, not to exercise vigorously. Some find that it is simply not possible as tiredness or chest pain prevent them from doing very much at all. Some get told that certain forms of exercise they used to enjoy might no longer be a good idea for the long term. This can be very upsetting.

This British Heart Foundation page gives information about what you can do when after a heart attack/surgery and answers some questions about exercise.

The general advice from Dr Adlam (from 39.58 minutes into this video), is that exercise is essential for maintaining physical and mental health.

Dr Adlam also notes that SCAD survivors should be wary of extremes. Some isometric poses, such as ‘the Plank’,  weight-lifting very heavy weights, any activity that puts them at risk of ‘whiplash’ type neck movement might (note: might, not will) increase the risk of further dissection events, particularly if you have also had a diagnosis of FMD (and particularly if that involves arteries and/or aneurysms in the brain).

Many will get back to doing the exercise they loved best of all. Perhaps not quite at the level they previously were at, but some exceed their previous fitness levels. SCAD patients have returned to running (including racing and half marathons etc), cycling (for leisure and competitively), horse-riding, skiing, sailing, hill-climbing etc. Have a look at some of our SCAD stories for some examples and inspiration!

But if new circumstances make one kind of exercise difficult, there will be a form of exercise that is possible, we just have to find it. Keeping moving is key – within personal safe limits, starting in moderation and slowly increasing speed/intensity of exercise. SCAD patients should talk to their cardiologist, Cardiac Rehab nurse, GP etc for guidance.

Physical (and mental) recovery after SCAD is definitely a marathon, rather than a sprint. Patients should take it one day at a time, be kind to themselves when they feel they aren’t making enough progress, keep a journal to encourage themselves.

What is the Borg Scale and should I use it?

Some patients are told by their doctors to keep their heart rate within certain parameters. This can vary person to person based on their pre/post-SCAD fitness and the impact of their SCAD on their heart. Trying to use monitors to maintain heart rate at a certain level can be quite stressful, especially as monitors are not always accurate.

Many cardiac rehab nurses teach their patients to use the Borg scale (a way of rating perceived exertion) instead.

The normal advice is to warm up carefully, then maintain a Borg Scale exertion level of 4-5 for 20 minutes and then warm down carefully.

Types of exercise that most SCAD patients can do at some level, gradually increasing distance and pace as stamina improves:

  • Walking
  • Swimming
  • Yoga (avoid isometric poses)
  • Pilates – see Cleveland Clinic’s information. (Although based in America, so some of the language may be unfamiliar, their website is both informative and sensible.)
  • Approved Cardiac Circuit Training or gym exercise machine use (linked with some Cardiac Rehab centres)
  • Aerobics for beginners

What about Cardiac Rehab?

Cardiac rehab is beneficial to SCAD patients as it will help them gain confidence in their bodies and recognise their abilities and limits. If you have not been offered cardiac rehab, please ask your GP/cardiologist to refer you.

See the British Heart Foundation’s information about cardiac rehab.

The University Hospitals of Leicester NHS Trust has created an online cardiac rehab programme, Activate Your Heart. They are currently offering this programme free to all NHS Trusts and have already set up more than 20 Trusts.

If you have had your cardiac rehab postponed or cut short due to the Covid-19 situation, please ask your cardiac rehab provider to investigate this option and contact Nikki Gardiner for more information. Nikki is the cardiac rehab lead in Leicester, who works with the SCAD research team so understands the cardiac rehab needs of SCAD patients.

How to perform CPR and use a Public Access Defibrillator in the event of cardiac arrest 

More than 30,000 people in the UK go into cardiac arrest outside of a hospital setting every year. CPR (Cardiopulmonary Resuscitation) and defibrillation are two life-saving techniques which can be used when this happens.

The vast majority of SCAD patients do not require CPR or the use of a defibrillator, but a few will.  

Knowing how to carry out CPR and how to use a Public Access Defibrillator or PAD (also often referred to as an AED or Automatic External Defibrillator), may make you and your family feel more confident, whether or not you had a cardiac arrest at the time of your SCAD.

Cardiac arrest happens when there are problems with the electrical signals in your heart. This stops the heart from doing its job of pumping blood around the body, eventually starving the brain of oxygen.

The signs of a cardiac arrest are easy to spot. A person will collapse suddenly. If shaking or shouting does not rouse them, and they have stopped breathing, or are breathing abnormally, they are in cardiac arrest.

CPR can be used while waiting for emergency help to arrive. And a defibrillator is used to deliver an electric shock through the chest wall to try to re-start the heart.

If a defibrillator is used to give a shock within the first minute of a cardiac arrest, there’s a 90% chance the person will survive. But for every minute that passes without a defibrillator, the person’s chance of survival goes down by 10% – so it’s essential to act quickly.

The British Heart Foundation has outlined the four steps to take if you find someone who is having a cardiac arrest:

  1. Call 999
  2. Start CPR (cardiopulmonary resuscitation)
  3. Ask someone to bring a defibrillator if there’s one nearby
  4. Turn on the defibrillator and follow its instructions

It might seem scary, but using a defibrillator is easy, as the device will instruct you in what to do. It will check the person’s heart rhythm and will tell you when to deliver a shock, and when to carry out CPR. The combination of CPR and defibrillation gives a person in cardiac arrest the highest chance of survival.

When you call 999, the call handler will tell you where your nearest defibrillator is, but if you can get to one even sooner, you could buy the vital seconds you need to help save a person’s life.

Many hospitals include lessons on CPR and using a defibrillator as part of their cardiac rehab sessions. If you have not had the opportunity to take these lessons, the following will be useful:

The British Heart Foundation provides instructional videos on both CPR and defibrillator use – including revised guidance on how to do CPR during the Covid-19 pandemic, avoiding ‘mouth to mouth’ contact.

These St John’s Ambulance videos explain how to give CPR to an adult, a child and a baby.

Click here to watch a video showing how to use a Public Access Defibrillator (PAD).

PADS are found in public places that can be accessed 24 hours a day, seven days a week by anyone. These places include: airports, railway stations, service stations, supermarkets, coffee shops, community centres etc. There are also thousands of other defibrillators across the whole of the NHS, including in ambulances and response cars, as well as in other emergency services vehicles such as police cars and fire engines. Then there are many other defibrillator locations that may not be classed as being ‘public access’ because they may be kept in a locked staff area of a school, for example, or in a building with restricted opening hours.

Every 16 October The Resuscitation Council together with The British Heart Foundation organises ‘Restart a Heart Day’ to increase the number of people who are trained in giving this life-saving intervention.

Having the confidence to use CPR or a defibrillator can and does save lives.

Counselling & therapy

General information, including how to refer yourself (you don’t need to access counselling via your GP)

Cognitive Behavioural Therapy (CBT)

EMDR (Eye Movement Desensitisation and Reprocessing therapy) to help treat post-traumatic stress disorder

EMDR Association

Medications to help with anxiety

NHS information on anxiety, fear and panic

NHS information on improving mental wellbeing 

Mind 

Mind information on anxiety and panic attacks 

Mindful 

Meditation and Mindfulness

NHS information on mindfulness 

Headspace 

Mindful information on mindfulness 

Practicing Gratitude (lots of information on this here but practising gratitude can be as simple as thinking of three things you are grateful for as you go to sleep, which will hopefully give you sweet dreams)

Breathing

Five-minute breathing meditation

Rectangular breathing – this is a really easy to learn and a very effective tool

Learning how to sleep better

Mental Health Foundation information on sleep

Sleep Council information on sleep

If you find any additional useful resources please email us so that we can review them.  Please also let us know if you discover any broken web links.