Psychological Hazards of Convalescence Following Myocardial Infarction

  • Howard A. Wishnie
  • Thomas P. Hackett
  • Ned H. Cassem
Part of the Current Topics in Mental Health book series (CTMH)


Three decades ago physicians commonly imposed a six-month convalescence upon patients recovering from myocardial infarction (MI). Since that time recommendations have undergone a liberal transformation. Not only has “early mobilization” become the aim for patients with an uncomplicated hospital course,1 but those discharged are now expected to return to normal activities and employment much earlier than ever before. Indeed, for asymptomatic patients with uncomplicated coronary disease, Friedberg permits resumption of occupation after six weeks of convalescence.2 Despite these liberal trends, there is a growing body of evidence to show that at least half the patients permitted to return to work are reluctant to do so and remain inactive for a prolonged period.If capable of work, why should a patient procrastinate? A number of authors have indicated psychosocial factors such as fear of recurrent infarction, anxiety, and depression.5-8,11,12 In a more recent comprehensive review, Miller and Brewer11 classify factors which influence progress in rehabilitation and cite psychological problems as heavy contributors to delayed convalescence.


Heart Attack Ischaemic Heart Disease Cardiac Rehabilitation Coronary Care Unit Recent Comprehensive Review 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Early mobilization after myocardial infarction, editorial. Lancet 1:821, 1969.Google Scholar
  2. 2.
    Friedberg, C. K. Diseases of the heart. Philadelphia: W. B. Saunders, 1966. Pp 922.Google Scholar
  3. 3.
    Gobel, A. J., Adey, G. M., & Bullen, J. F. Rehabilitation of the cardiac patient. Medical Journal of Australia 2:975–979, 1963.Google Scholar
  4. 4.
    Wincott, E. A., & Caird, F. I. Return to work after myocardial infarction. British Medical Journal 2:1302–1304, 1966.PubMedCrossRefGoogle Scholar
  5. 5.
    Weinblatt, E. et al. Return to work and work status following first myocardial infarction. American Journal of Public Health 56:169–185, 1966.PubMedCrossRefGoogle Scholar
  6. 6.
    Wynn, A. Unwarranted emotional distress in men with ischaemic heart disease (IHD). Medical Journal of Australia 2:847–851, 1967.PubMedGoogle Scholar
  7. 7.
    Kellerman, J.J., Levy, M. et al. Rehabilitation of coronary patients. Journal of Chronic Diseases 20:815–821, 1967.CrossRefGoogle Scholar
  8. 8.
    Groden, B. M. Return to work after myocardial infarction. Scottish Medical Journal 12:297–301, 1967.PubMedGoogle Scholar
  9. 9.
    Klein, R. F., Dean, A., & Willson, I. M. et al. The physician and postmyocardial infarction invalidism. JAMA 194:143–148, 1965.PubMedCrossRefGoogle Scholar
  10. 10.
    Aides, J. H, Stein, S. P., & Grabin, S. A program to effect vocational restoration of “unemployable” cardiac cases. Diseases of the Chest 54:518–522, 1958.Google Scholar
  11. 11.
    Miller, G. M., & Brewer, J. Factors influencing the rehabilitation of the patient with ischaemic heart disease. Medical Journal of Australia 1:410–416, 1969.PubMedGoogle Scholar
  12. 12.
    Birock, G. Social and psychological problems in patients with chronic cardiac illness. American Heart Journal 58:414–417, 1959.CrossRefGoogle Scholar
  13. 13.
    Hackett, T. P., Cassem, N. H., & Wishnie, H. A. The coronary care unit: An appraisal of its psychological hazards. New England Journal of Medicine 279:1365–1370, 1968.PubMedCrossRefGoogle Scholar
  14. 14.
    Klein, R. F. et al. Transfer from a coronary care unit: Some adverse responses. Archives of Internal Medicine 122:104–108, 1968.PubMedCrossRefGoogle Scholar
  15. 15.
    Adsett, C. A., & Bruhn, J. G. Short term group psychotherapy for postmyocardial infarction patients and their wives. Canadian Medical Association Journal 99:577–584,1968.PubMedGoogle Scholar
  16. 16.
    Julian, D. G. Acute myocardial infarction. Baltimore: Williams & Wilkins Co, 1968.Google Scholar
  17. 17.
    Bethesda conference report: Early care for the acute coronary suspect. American Journal of Cardiology 23:603–618, 1969.CrossRefGoogle Scholar
  18. 18.
    Goldstein, S., & Moss, A. J., (Ed). Symposium on the pre-hospital phase of acute myocardial infarction: Part I. American Journal of Cardiology 24:609–688, 1969.Google Scholar

Copyright information

© Plenum Publishing Corporation 1977

Authors and Affiliations

  • Howard A. Wishnie
    • 1
  • Thomas P. Hackett
  • Ned H. Cassem
  1. 1.Harvard Medical SchoolCambridgeUSA

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