Not just for soldiers anymore: PTSD after a heart attack

by Carolyn Thomas   ♥  @HeartSisters

When I was at my WomenHeart Science & Leadership training at Mayo Clinic, we watched a short film about women and heart disease. A 40-something woman onscreen told the interviewer that ever since her heart attack had happened, she was afraid to go to sleep every night, because now she wasn’t sure that she would ever wake up.

I began to weep when I heard her say this.

For the previous five months since my own heart attack, I’d been somehow compelled to clean the entire apartment every night before bedtime, “just in case”. I emptied trash, recycled  all newspapers, swept and scrubbed and tidied.  I was unknowingly planning that, if this were the night I was going to have another heart attack, the paramedics and the coroner and (worse) my grown kidlets would find my corpse in a nice clean place.  When I finally did fall asleep, I’d have terrifyingly frequent nightmares about having a heart attack on the plane (vividly reliving what had actually happened in May 2008) but this time, when I looked around the plane in my dreams, there were no passengers – and no pilots. 

It suddenly struck me on that autumn day at Mayo Clinic that every night since May 6, 2008, I had been essentially preparing for my own death. Night after night, month after month. And I was utterly exhausted.

The only upside: the place had never been so clean. 

But it was clear to my physicians that many of my bleak and distressing symptoms were those consistent with Post-Traumatic Stress Disorder (PTSD).*

This is a debilitating condition that can develop when you experience or even witness a dangerous, terrifying, or possibly life-threatening stressful event – an event that is outside the range of what’s considered to be a normal human experience.

About 7-8% of the general population will develop PTSD over their lifetimes, but for military veterans, rape victims and, yes, heart attack survivors, this number can go up to an astonishing 30%.

And now a U.K. study(1) led by Dr. Susan Ayers at the University of Sussex published in the British Journal of Health Psychology suggests that heart attack survivors may have a disturbing incidence of undiagnosed PTSD.  Her research team found that 16% of survivors studied met clinical criteria for acute PTSD, and a further 18% reported moderate to severe symptoms. Dr. Ayers explains:

“Feelings of fear, anxiety and depression are common after a life-threatening cardiac event. The findings of this study suggest that a high proportion of survivors experience very severe distress.  This has the potential to impair recovery, quality of life and threaten future health.”

Montreal Heart Institute researchers found that, one month out, a significant number of heart attack victims show clear symptoms of PTSD such as:

• frequent nightmares or flashbacks
• a constant reliving of the fear, helplessness or horror felt when they were having the heart attack and thought they were dying

Dr. Donald Edmondson, assistant professor of behavioural medicine at Columbia University, adds that people who feel more in danger during a medical trauma, or who feel they have less control of their health, also are more likely to experience the condition.

How are heart attack survivors treated for PTSD?  Like many anxiety disorder treatments, medication, regular exercise and therapy are often the most helpful treatments, the sooner the better, before symptoms worsen. According to Dr. Ayers:

“It is vitally important that heart attack survivors are screened for psychological distress, such as anxiety, depression and PTSD, and offered appropriate treatment if necessary.”

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More about Post Traumatic Stress Disorder:

This condition has been around forever and known by different names: soldier’s heart, combat fatigue,  shell shock,  gross stress reaction,  post-Vietnam syndrome.  But it wasn’t until 1980 that it was officially added to the bible of mental illness knowledge, the Diagnostic Manual of Mental Disorders (DSM) after Vietnam war vets lobbied to have PTSD recognized as a legitimate condition.

PTSD can also strike both survivors and relief workers at natural or terrorist disasters, and anyone who has either experienced or witnessed this kind of trauma.

New York City’s World Trade Center Health Registry reported that 20% of New Yorkers who lived below Canal Street (close to the World Trade Center) were estimated to suffer from PTSD following the 9/11 terrorist attacks in 2001 compared to 11% of all New York City residents. About 5% of 9/11 trained relief workers were diagnosed with PTSD as a result of just listening to the horrific stories from survivors of the attacks. Hardest hit among relief workers were those who were pulled off their regular jobs to perform tasks they were not prepared for – like the city’s sanitation workers who were assigned to help with search and rescue, or relief workers who spent more than 90 days at Ground Zero. Most relief workers showed no further symptoms six months later, but Twin Towers survivors themselves reported suffering PTSD symptoms up to five years after the attacks.

A Harvard Medical School study of survivors of Hurricane Katrina in New Orleans found ‘delayed onset’ PTSD symptoms that actually increased over the first two years following.  The worst-affected Katrina survivors were both close to the epicentre of the tragedy as well as abandoned on their own without help for far too long – both extremely dangerous PTSD risk factors.

For military personnel serving in the Middle East war, the PSTD numbers are frightening:

• one in six soldiers will return suffering from PTSD
• enlisted soldiers are twice as likely as military officers to report PTSD
• women soldiers tend to suffer from more severe and debilitating forms of PTSD

And the newly released results of a 60-year study out of the University of Florida have shown that heavy combat exposure at a young age had a detrimental effect on physical health and psychological well-being for about half of the soldiers well into their 80s, These findings were published in the latest issue of the journal Research in Human Development.  But researchers point out that the Ivy League-educated World War II veterans studied for 60 years (all Harvard undergraduates from 1940-44) were probably much better off than today’s veterans because their educational background let them serve in better positions than the average enlisted soldier today.

Complete this assessment to learn if the symptoms you might be having are consistent with a PTSD diagnosis.

* UPDATE, August 13, 2013:  U.S. Staff Sargent and military Medal of Honor recipient Ty Carter has launched a campaign to remove the D from PTSD:

“Post Traumatic Stress Disorder is really a formal diagnosis for natural stress that one experiences after a traumatic event. The formal title of PTSD sometimes gives a false impression that the ‘disorder’ is something associated with a disease or a chemical imbalance, when in reality it is simply a biological response. Three steps are necessary to successfully treat the condition:

• acknowledging one has symptoms
• communicating with others about it
• seeking treatment without fear of judgment

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(1) Ayers S, Copland C & Dunmore E (2009). A preliminary study of negative appraisals and dysfunctional coping strategies associated with post-traumatic stress disorder symptoms following myocardial infarction. British Journal of Health Psychology, 14(3), 459-471.

See also:

The New Country Called Heart Disease

A Foreshortened Future

Women Heart Attack Survivors May Be As Psychologically Traumatized as Victims of Violence

“I’m Not Depressed!” And Other Ways We Deny The Stigma Of Mental Illness

10 Non-Drug Ways to Treat Depression in Heart Patients

9 Myths About PTSD (excellent article by Megan Thielking in Vox.com)

© Carolyn Thomas www.myheartsisters.org

Note:  information on this site is not intended as a substitute for expert medical advice. Please consult your physician for specific health information.

NOTE FROM CAROLYN:  I wrote more about mental health issues and heart patients, including PTSD, in my book, A Woman’s Guide to Living with Heart Disease (Johns Hopkins University Press).