Heart attack can trigger PTSD

A heart attack is a life-changing event. For some people, surviving a heart attack brings renewed appreciation for life. For others, the event is so traumatic that worrying about having a second heart attack consumes their lives.

By the latest account, 1 in 8 heart-attack survivors experiences a reaction that might be called post-traumatic stress disorder (PTSD). Although PTSD is usually associated with extreme trauma such as war, rape, or a natural disaster, heart-attack survivors can experience the same key symptoms: flashbacks that occur as nightmares or intrusive thoughts. As a result, the survivor actively tries to avoid being reminded of the event and becomes hypervigilant worrying that it will happen again.

It’s a high price to pay for having your life spared.

“Everyone knows that a heart attack is a serious medical condition. What might not be as obvious is the psychological trauma that can result from having a major heart attack—especially the fear that it might occur again and cannot be predicted. In a small proportion of patients, this fear itself can be disabling,” says Dr. Deepak Bhatt, chief of cardiology at the VA Boston Medical Center and a professor at Harvard Medical School.

The 1 in 8 number comes from researchers in New York and Boston, who searched all observational studies relating PTSD to heart attack published since 1948. In the 24 that met their inclusion criteria, the mean age of those who experienced this extreme reaction varied from 53 to 67. The researchers found that the diagnosis of PTSD was significantly more common in younger heart-attack victims, without regard to gender. In the three studies that reported clinical outcomes, heart-attack survivors with PTSD had double the risk of dying or experiencing a second heart attack as those without PTSD. The work was published online in PLoS One.

And although heart attack severity was not recorded in most of the studies that were analyzed, Dr. Bhatt suspects that PTSD might be more likely to occur when a person dies from the event and is resuscitated.

As treatments for heart attack continue to improve, 1.4 million people a year are now surviving the event long enough to be discharged home. If the study is correct, 168,000 of them will be diagnosed with PTSD every year. It’s a grim reminder that as we get better at fixing the body, we must recognize the need to treat the mind.

“The connections between the heart and mind are powerful, and we are only starting to understand these linkages,” says Dr. Bhatt.

Recognizing and treating PTSD

The symptoms of PTSD can arise suddenly, or come on gradually. There are three main types of symptom:

• Re-experiencing the traumatic event
  • intrusive memories of the event
  • flashbacks
  • nightmares
  • intense reactions to reminders of the event, such as pounding heart, rapid breathing, muscle tension
• Avoiding reminders of the traumatic event
  • trying to avoiding activities, places, thoughts, or feelings that are reminders of the event
  • loss of interest in activities and life in general
  • feeling emotionally numb
• Increased anxiety and emotional arousal
  • trouble falling asleep or staying asleep
  • irritability or anger
  • difficulty concentrating
  • being easily startled

If you recognize one or more of these symptoms in yourself or someone else after a heart attack or other traumatic event, don’t write it off as something that will pass. Identifying PTSD early is an important step to coping with it. The sooner treatment is started, the more likely it will be successful.

Treatment generally includes a type of “talk” therapy known as cognitive-behavioral therapy. It may also include an antidepressant such as Prozac or Zoloft. An experimental treatment known as eye movement desensitization and reprocessing (EMDR) may also help.