Post-Traumatic Stress Disorder Strikes One in Eight Heart Surgery Patients

By Anne Curley

Post-Traumatic Stress Disorder (PTSD) usually is associated with military personnel traumatized by combat or people who’ve been victimized by violent crime or sexual assaults.

But new study finds that one in eight patients develop PTSD after experiencing a heart attack or other major heart event. The study, published online in PLoS One, also reveals that heart patients who experience PTSD face double the risk for another heart event or dying within one to three years, compared to heart patients who do not experience PTSD.

Scientists from Columbia University Medical Center performed the first meta-analysis of studies examining PTSD induced by major heart events. The studies included almost 2,400 patients who experienced acute coronary syndrome or ACS, an umbrella term medical professionals use to describe any condition that reduces blood flow to the heart, including heart attacks and unstable angina.

“Everybody is expected to have some disruption after a life threatening event such as a heart attack,” explained lead study author Donald Edmondson, assistant professor of behavioral medicine at Columbia University Medical Center, “but after a month we expect people to mostly get back to normal.” Edmondson said their research focused on studies of patients who experienced symptoms of PTSD more than one months after their heart event.

“These studies measured PTSD symptoms intrusive thoughts about the heart attack – out of nowhere that sort of fight or flight response to these memories. People also have nightmares about the event, they have sleep disruptions, they actively avoid thinking about the heart attack, they try to manage their thoughts,” said Edmondson.

More than 1.4 million people in the U.S. are discharged each year from hospitals after suffering acute coronary syndrome, explained Edmondson, If 12% of those patients experience clinically significant symptoms of PTSD, that means that 168,000 patients could experience PTSD each year after heart events.

While medical professionals are keenly aware of the association that has been shown between depression and heart attacks, Edmondson believes that making patients, their families and medical professionals aware of the incidence of PTSD after heart events is critical.

Edmondson said when he’s discussed findings about PTSD with cardiologists, they’ve told him 'I thought these were funny depression symptoms. I knew there was something wrong here but I didn’t have a language for it.'  

Edmondson said that while PTSD and depression often travel together, "PTSD symptoms are unique – the experience of intrusive thoughts, the nightmares, the inability to shake thinking certain thoughts, the fight or flight symptoms are unique to PTSD. For a patient or a cardiologist who’s not looking for PTSD, once you know the symptoms, they sort of jump out and they’re unique to PTSD."

“Despite the variation in the estimates of the prevalence PTSD appears to be a reasonably common occurrence after ACS and seems to be associated with worse outcomes,” said Dr. Gordon F. Tomaselli, president of the American Heart Association.  "Further study is warranted but practitioners need to be alert to the possibly of PTSD after ACS and should institute treatment.”

“Physicians and patients have to be aware that this is a problem. Family members can also help,” said Edmondson.  "There are good treatments for people with PTSD,” Edmondson noted, explaining that the best treatment is an “exposure based talk therapy," in which the patient talks about the traumatic experience, reliving it in an effort to desensitize them to the event.