Surprise, Surprise… Heart Attack Patients Have Increased Risk of Developing PTSD

Imagine this scenario:

You develop squeezing, crushing pain in the center of your chest that radiates to your jaw and left shoulder.  The chest pain feels like an elephant is sitting on your chest.  It causes sweating, nausea, and takes away your breath.  You suddenly start having fluttering palpitations and your heart races.  After a few minutes, the pain subsides only to come back with even more intensity and ferocity.  This time the nausea becomes so intense that you vomit.  Anxious and concerned for your life, you call 911 and paramedics arrive, place oxygen in your nose, give you aspirin and sublingual nitroglycerin, and rush you to the nearest ER.  The ER doctor performs an ekg and tells you he sees “tombstones” and that you are having a heart attack which could kill you.  The ER doctor calls his cardiologist friend, who tells you that you need to have a procedure called a cardiac catheterization to open the blocked artery (or arteries) in your heart.  You are suddenly rushed to the cath lab, and a catheter is inserted into your groin and threaded up into your heart to insert a “stent” to open the blockage.  You later find out that your life was saved – without the procedure you would have died.

Rhetorical Question: Is this experience a traumatic one?

ACS or acute coronary syndromes (myocardial infarction i.e. heart attack and unstable angina) have long been known to be associated with post-event depression.  Researchers from Columbia University Medical Center in New York City, lead by Dr. Donald Edmondson, have found that patients who suffer an acute coronary syndrome, such as heart attack, are at increased risk of developing post traumatic stress disorder (PTSD).  The results of their research were published online in the journal PLoS ONE.  The researchers performed a meta-analysis of 24 studies which analyzed data for a total of 2,383 heart attack patients.  The meta-analysis showed that one in eight, or 12%, of patients who suffer a heart attack or other acute coronary event were subsequently found to have clinically relevant PTSD symptoms.  In addition, the study results showed that 4% of heart attack survivors meet the diagnostic criterion for PTSD.  It is estimated that approximately 1.4 million people in the United States will suffer an acute coronary event each year.  That would mean that 168,000 heart attack survivors would develop clinically significant PTSD symptoms each year.  This is a very large number of people – enough to warrant screening for the disorder in post myocardial infarction patients.  The researchers also found that acute coronary syndrome patients with PTSD symptoms had double the likelihood of having another heart attack or even death.  The study investigators theorize that this increased risk develops due to exaggerated inflammation in PTSD, which is also known to increase risk for a second heart attack.  In addition, patients with PTSD may be more non-compliant with medication due to the fact that the medicines may serve as triggers for the trauma.  Patients with PTSD are known to avoid any trigger which could remind them of the traumatic event.  The authors wrote, “While awareness of depression has increased in cardiology practice, awareness of the possibility of PTSD due to ACS has lagged, possibly because many still see PTSD as primarily a disorder of combat veterans or sexual assault survivors… Pharmacologic and psychotherapy treatments for PTSD due to noncardiac events reduce PTSD symptoms and might reduce accompanying inflammation, potentially producing more favorable clinical outcomes in ACS patients. It seems likely, but has not yet been tested, that reducing symptoms of PTSD could improve adherence to post-ACS treatment regimens”.  Future research should focus on the treatment of PTSD in heart attack survivors and determine whether successful treatment of PTSD can decrease the risk of another heart attack.

Listen to the MedPage Today interview with Dr. Donald Edmondson below:

Reference:

Edmondson D, Richardson S, Falzon L, Davidson KW, Mills MA, Neria Y “Posttraumatic Stress Disorder Prevalence and Risk of Recurrence in Acute Coronary Syndrome Patients: A Meta-analytic Review” PLoS ONE 2012 7(6): e38915. doi:10.1371/journal.pone.0038915

Tagged as: ACS, acute coronary syndrome, depression, Dr. Donald Edmondson, heart attack, myocardial infarction, post traumatic stress disorder, PTSD, unstable angina