Heart Disease Occurs in a Biological, Psychological, and Social Matrix: Cardiac Risk Factors, Symptom Presentation, and Recovery as Illustrative Examples

Abstract

Despite the basic premise of behavioral medicine that understanding and treatment of physical well-being require a full appreciation of the confluence of micro-, molar-, and macro-variables, the field tends to focus on linear, causal relationships. In this paper, we argue that more attention be given to a dynamic matrix approach, which assumes that biological, psychological, and social elements are interconnected and continually influence each other (consistent with the biopsychosocial model). To illustrate, the authors draw from their independent and collaborative research programs on overlapping cardiac risk factors, symptom interpretation, and treatment delay for cardiac care and recovery from heart disease. "Cabling" across biological, psychological, and social variables is considered as a transformative strategy for medicine and the other health-related disciplines.

Factors influencing participation in cardiac rehabilitation programmes after referral and initial attendance: qualitative systematic review and meta-synthesis

“…92 In affluent late modern societies, these factors are common in consumer behaviour related to shopping, eating, and even healthcare. 92 These behaviours, likewise, tend to be guided less by simple cost-benefit analyses than a web of factors linked to self-identity and personal values, 93,94 and how these tally to the branding and perceived values of that which is being consumed. 95 Ironically, most patients see programmes as being intended for patients who are less healthy than they are, but provided by professionals who are more focused on health than they are.…”

In Sickness and in Health: a Literature Review about Function of Social Support within Anxiety and Heart Disease Association

“…Anxiety activates the sympathetic nervous system (SNS) [10, 26], causing the release of epinephrine, norepinephrine and producing arrhythmias [27]. Anxious subjects respond to stressors with greater psychophysiological arousal in terms of sympathetic nervous system (SNS) and hypothalamic-pituitary-adrenal (HPA) activation [28] that, in turn, are associated with elevated catecholamine levels, leading to vasoconstriction, platelet aggregation and elevated heart rate [29]. Also indirect mechanisms may affect health through unhealthy lifestyles [7] and maladaptive coping behaviors (such as cigarette smoking, proper diet, adherence to medication, adequate physical activity) [30].…”

Explicaciones no atendidas sobre las brechas de género en la enfermedad cardiovascular ¿Cómo entender diferencias de género en el infarto de miocardio?

“…En relación con la presentación clínica de la enfermedad, estudios muestran que podrían existir dificultades de diagnóstico de IAM en mujeres, dado a que se manifiesta con síntomas atípicos o difusos 1,5,9,10,11 , de muy baja ocurrencia en varones 12 . El tratante puede confundir relatos de síntomas de angina con estrés o depresión 10 . Estas dimensiones poco frecuentes pueden tener relación con fenómenos ajenos a la sola diferencia anatómica entre sexos, como, por ejemplo, la construcción social de la misma enfermedad 10 .…”

“…El tratante puede confundir relatos de síntomas de angina con estrés o depresión 10 . Estas dimensiones poco frecuentes pueden tener relación con fenómenos ajenos a la sola diferencia anatómica entre sexos, como, por ejemplo, la construcción social de la misma enfermedad 10 .…”