Depression and Anxiety in Pulmonary Hypertension Associated With Congenital Heart Disease: Pathophysiology and Clinical Implications of the Heart–Brain Axis

Pulmonary hypertension associated with congenital heart disease or PH-CHD is an increasingly prevalent disorder in modern cardiology. It is characterized by progressive pulmonary vascular remodeling, chronic right ventricular (RV) pressure overload, and abnormal cardiopulmonary hemodynamic. Due to advances in congenital cardiology and treatments for pulmonary hypertension, survival rates have increased. As a result, the focus has switched to long-term functional status and quality of life. Depression and anxiety are currently recognized as prevalent and clinically significant manifestations in PH-CHD; nonetheless, they remain underdiagnosed and undertreated within cardiovascular care frameworks. More study shows the disease's severity or symptom count cannot explain PH-CHD patients' psychological distress. Instead, it shows a chronic heart disease-induced pathogenic process. The heart-brain axis underlines this idea. Chronic pulmonary vascular disease and RV failure induce neurohormonal activation, autonomic instability, systemic inflammation, hypoxia, and inadequate cerebral perfusion, which affect brain structure and emotion regulation. This brief review gathers evidence of objective cardiovascular dysfunction linked to depression and anxiety in PH-CHD, and investigates into the molecular pathways that connect the heart and brain. The ideas of psychological distress as a factor associated with chronic cardiovascular disease requires a more extensive interdisciplinary approach, which may ultimately affect favorable patient outcomes and long-term prognosis.