JIPMER Nursing Officer-2017
Medical & Surgical Nursing
Easy
Which condition places a patient with cardiac illness at increased risk of sudden death?
Appeared in: JIPMER Nursing Officer-2017
Explanation
- Depression is a well-established, independent risk factor that can double the risk of adverse outcomes, including death, in patients with pre-existing cardiac disease.
- The link is supported by strong evidence from numerous large-scale, prospective studies and meta-analyses.
- Biological mechanisms include autonomic nervous system dysfunction (which reduces heart rate variability), increased platelet aggregation (raising thrombosis risk), and elevated systemic inflammation.
- Behavioral mechanisms also play a crucial role, such as poor adherence to cardiac medications, diet, and exercise, as well as a higher prevalence of smoking.
Why Other Options Were Wrong
- Option B: While anxiety is common in cardiac patients and can cause distressing symptoms like palpitations, its role as an independent predictor of sudden death is less established and considered weaker than that of depression.
- Option C: The primary risk from bulimia in a cardiac context stems from electrolyte disturbances, particularly hypokalemia, which can provoke arrhythmias. However, depression is a much more prevalent and broadly impactful risk factor in the general cardiac population.
- Option D: Chest pain (angina) is a symptom or a manifestation of the underlying cardiac illness itself (e.g., coronary artery disease), not a separate comorbid condition that adds risk. It signals active disease but is not an independent risk factor in the same category as depression.
Related Visual
Clinical Relevance
- Nursing practice connection: Use the key finding related to Psychosocial Risk Factors in Cardiovascular Disease to guide bedside assessment, documentation, and the next nursing action.
- It is a critical nursing responsibility to screen all patients with cardiac disease for depression, as it is a treatable condition that significantly impacts mortality.
- The SADHART and CREATE trials, though with some nuances, have shown that treating depression (e.g., with sertraline) in cardiac patients is safe and can improve mood, highlighting the importance of integrated mental health care.
- Nurses should educate patients and families about the 'mind-heart' connection and encourage open discussion about mood and stress.
How to Approach the Question
- First, identify the core of the question: it asks for a condition that adds to the risk of sudden death in a patient who already has a cardiac illness.
- Next, categorize the options. 'Depression' and 'Anxiety' are psychological comorbidities. 'Bulimia' is a psychiatric disorder with specific physiological consequences. 'Chest pain' is a physical symptom.
- Critically evaluate 'Chest pain'. Recognize that it is a symptom of the cardiac illness itself, not a separate condition that adds risk. This makes it the least likely correct answer in this context.
- Compare the remaining options (Depression, Anxiety, Bulimia). All can theoretically increase risk. Recall or reason which has the strongest and most widely established evidence base as an independent risk factor for mortality in the general cardiac population.
- Conclude that while all have plausible mechanisms, depression is consistently identified in major studies as the most significant psychosocial predictor of adverse cardiac outcomes, including death.
Concept Tested & Keywords
- Concept Tested: Psychosocial Risk Factors in Cardiovascular Disease
- Stem keywords: cardiac illness, increased risk, sudden death
- Lead-in keywords: Which condition
Question ID
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Reference Book
E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) pp. 7300-7302, 7337-7339, 7334-7336
Practise the full JIPMER Nursing Officer-2017
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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