Depression and chronic fatigue in the patient with heart disease.

Depression and chronic fatigue are frequently associated with heart disease. They may precede the onset of myocardial infarction, singly or together, and increase the morbidity and mortality of patients with a history of MI. Virtually all such patients have a transient depression, usually accompanied by anxiety, with onset soon after hospitalization. Although this depression is transient and usually abates spontaneously, it frequently warrants therapeutic intervention. Psychosocial and personality factors play a significant role in the recovery of a patient with a cardiac condition. The clinician must be alert for the effects of changing roles within the family and behaviors that may lead to chronic invalidism. Anxiety disorders, often combined with depression, may mimic cardiac disease and may result from it, leading to chronic fatigue and weakness. Proper diagnosis usually leads to considerable improvement. Cardiac drugs, in addition to many others, may produce depression and fatigue that may be misdiagnosed. Often, discontinuing or changing a medication will lead to marked diminution of such symptoms. Observational and listening skills are key ingredients of the "art" of medicine; they can lead to interventions that are not only therapeutic, but which improve the "quality" of life.