by Carolyn Thomas ♥ @HeartSisters
This guest post was originally posted online by Holly Strawbridge of Harvard Health Publications on June 25, 2012.
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, one in eight heart attack survivors experiences a reaction 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 hyper-vigilant worrying that it will happen again.
It’s a high price to pay for having your life spared.
Dr. Deepak Bhatt, chief of cardiology at the VA Boston Medical Center and a professor at Harvard Medical School, says:
“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.”
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 the journal, Public Library of Science One (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.
It’s a grim reminder that as we get better at fixing the body, we must recognize the need to treat the mind.
Understanding post-traumatic stress disorder*
Dr Bhatt explains:
“The connections between the heart and mind are powerful, and we are only starting to understand these linkages.”
Recognizing and treating PTSD
The symptoms of PTSD can arise suddenly, or come on gradually. There are three main types of symptoms:
1. 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
2. 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
3. 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, and in severe cases may be helped by antidepressants.
A non-drug treatment known as eye movement desensitization and reprocessing (EMDR) may also help.
© 2012 Harvard Health Publications
* From Longwood Seminars, April 10, 2014.
See also:
Women heart attack survivors may be as psychologically traumatized as victims of violence
Not just for soldiers anymore: Post-Traumatic Stress Disorder after a heart attack
Why hearing the diagnosis can hurt worse than the heart attack
Having a heart attack? Call 911 – and pack your Tetris game
Looking for meaning in a meaningless diagnosis
10 non-drug ways to treat depression in heart patients
The new country called Heart Disease
Image: Joep Roosen, Amsterdam
Q: Have you experienced PTSD following a cardiac event?
NOTE FROM CAROLYN: I wrote more about heart patients and mental health issues (including PTSD) in my book, A Woman’s Guide to Living with Heart Disease (Johns Hopkins University Press).
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Heart Sisters 
Hello. I had a heart attack 3.5 years ago when I was 43 years old. I had 100% blockage of the LAD, and a 80% blockage in my RCA. Hearing the words “heart disease” while in recovery was almost as frightening as the heart attack itself.
Ever since then, I’ve spent every waking moment worrying about having a second cardiac event. It’s consumed my life.
In addition, I’ve been battling clinical depression and severe anxiety for 20-plus years. I have never felt more helpless than I do now.
Any advice would be greatly appreciated.
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Hello Todd – you were very young to have had to undergo such a serious cardiac event. And your history of depression/anxiety made your current state of worrying almost predictable. I’m not a physician but I can tell you generally that the first year post-heart attack seems to be the most critical in terms of anticipating that second cardiac event to happen. You’ve long surpassed that one year “heartiversary” by now; 3.5 years of this torture is enough.
After my own heart attack, I became convinced I would die in my sleep. Every evening, I tidied the apartment, cleared counters, emptied the recycling bins – all so that when I died that night in bed, the place would be nice and tidy when the paramedics (or worse, my grown children) discovered my corpse the next day. This went on for a long time, night after night, until one day I sat up and realized: “I have not died yet! All I’ve done is wasted all that time preparing for my own death – all for nothing!” I’m guessing you have a family doctor who has referred you to mental health supports – if not please seek help immediately to talk to a professional about what you’ve been going through. Good luck to you…
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Thanks for your reply, Carolyn. I haven’t spoken to any type of mental health professional since my heart attack. I don’t have health insurance, and can’t afford to see one with my low income. It’s nice to know I’m not alone with the way I feel, even tho I’m sorry you had a similar experience.
The worst part of it, at the moment, is my anxiety seems to be rubbing off on my Jack Russell. She just recently started showing signs of severe separation anxiety after 14 years, and I feel like it’s my fault.
I too felt like I was going to die in my sleep in the weeks following the heart attack. It’s hard to explain what I’m going through to any friends or my family simply because they don’t know the horror of having a heart attack combined with the worst panic attack I could possibly imagine.
At this point, it’s becoming very difficult to function “normally” and force myself to go to work every day, but I’m not ready to give up just yet. I have to be here for my dog. She’s all I have left, and she means the world to me.
Thanks you again for your reply. I wish you the best.
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Todd, I went through something similar after my heart attack 2 years ago. I would say that it helps having regular check-ups and testing done, so as to reassure yourself that your CAD is not progressing. The thing is, you are now taking medication, have an improved lifestyle and under better care than the non-existent care before the event (at least that is my case), so the probability of having another one is lower.
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Tudval, I see my general practitioner a couple times a year, but haven’t seen a cardiologist since August of 2017. The test results at that time were optimal. Cigarettes were the culprit of my heart attack. My weight, and cholesterol weren’t a factor. Unfortunately, I’ve “quit” smoking multiple times since then, but I keep going back to them. Between the constant worry/stress, and the cigarettes, I feel like a ticking time bomb. For the fourth year in a row, quitting is my New Year’s resolution, once again.
Thanks for your reply.
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One in EIGHT? That explains it. Husband can still remember how unhappy he was, 18 years ago, when he woke up from his quadruple bypass with a breathing tube. It was the worst part of the whole thing that they wouldn’t remove it for 24 hours.
I’ve been journaling like crazy since I got home from the doctor visit the day after I left the hospital after the third catheterization and the blowout in the femoral artery that kept me there one more day – and I will continue to do so, as CBT is my only choice. I’m good at it, but I’m just realizing, after reading these posts and comments, that I need to be very thorough and take my time (and ask for help if I don’t manage it!), because this depression and the aftereffects may be very serious.
It’s probably part of why I can’t just return to writing the fiction I was working on when the ‘kick in the chest by a mule’ pain started. Fortunately, writing is what I do (yeah, I know – my comments are too long, too).
Over and over, thanks for this blog and all the posts.
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Alicia, although things may seem pretty awful right now, you’re farther ahead than most freshly-diagosed heart patients because you’re already saying: “I need to be very thorough and take my time (and ask for help…”) Brilliant! Most patients don’t come to that conclusion for a long time – if ever! – thus making a bad situation 1,000 times worse. You didn’t develop your cardiac condition overnight, and it’s going to take time to heal both physically and emotionally. Opportunity to practice being as patient with yourself as you would be if a loved one were going through what you are.
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I am really working on it. Thanks for your reply.
That’s part. I haven’t eaten anything good in so long (I stay away from the carbs – they mess with my mind) – but being relatively immobile because of the CFS and back problems can’t possibly help. I’m hoping to work up to a nice walk around my block one of these days, but my physiatrist says I need back surgery again – and I don’t even want to think about what that will do. The first time cost me almost a year of my life, incredible pain, and I still couldn’t walk. More doctors lying. And of course now there are the stents…
I’m trying to understand, and to do the right thing.
I never had a ‘cardiac condition’ until all of a sudden. I know it was developing in that particular artery, but the stress is coming from the process and wondering what would have happened if I hadn’t gone to see my doctor (NOT the cardiologist – they’d released me after the first stent to find my cause for the non-cardiac chest pain).
It’s still a big knot. You’re right.
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I suffered from massive PTSD following my double lung transplant in 1998. I was blessed that I had such supportive family and friends, but that doesn’t help on those dark nights of the soul when you’re alone in your hospital room.
For three month after my transplant, I was on IV antivirals and over time I had to go to ICU to have a central line put in; I needed solid sedation or I’d hyperventilate and panic. Needless to say, I was SO happy when finally my central line was removed. Seventeen years later, I still have horrible memories of some nights in ICU and when I was moved to the wards when things went wrong and I thought I was going to die, like when I went into end stage rejection.
PTSD post life-altering surgery is something that doctors often know very little about. Thank you for writing about it.
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I’ve been writing about PTSD for a number of years (or running guest posts like Holly’s) ever since I was diagnosed myself after surviving a heart attack. You raise such an important point, which is the essential “alone-ness” of this emotional suffering – no matter how many caring family members or friends you may have outside in the waiting room. In fact, sometimes we try hard to mask that suffering (what sociologists call “emotional labour” – pasting on a happy face/suppressing feelings to provide a welcoming outward appearance in order to make others feel less worried about us). Thanks for sharing your unique perspective here, cjm, and also for the link to your blog, Bruises You Can Touch. I love what you’re writing!
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Thank you so much for commenting, Carolyn. I’m really enjoying your writing from the perspective of a patient and survivor of PTSD. Emotional labour is something I’m hyper-aware of … I used to be a master at it. I still feel as though I need to be ‘ok’ for everyone. I don’t know if that ever goes away after doing for nearly 39 years!
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I just went through a ream of paper printing out your articles Carolyn. Each topic is so humananely on target and your titles speak directly to ‘burning issues’ facing heart patients. Plus I enjoy your combo of brisk journalistic writing and ‘frickety-frackin’ heart attack’ lingo. A great signal you are well acquainted with post heart attack inner life.
It was 13 years before I was first diagnosed with PTSD from heart attack, interestingly by a PhD Psychotherapist specializing in anxiety disorders who also was in charge of 58 Iraq/Afghanistan war vets with varying degrees of PTSD. (I’m also in the population that feels precisely which ovary is ovulating..ooww…and Prozac/SSRIs are extremely dangerous, creating a swift amplification of extreme agitation and anxiety that requires days to ease down.)
My system requires SEDATION, hence a Xanax prescription. Swift sedation offers some protection while being hospitalized. I believe drugs for depression require a qualified phsician/therapist working long term with patients after discharge, when they have recovered enough to think normally and a customized treatment path can be explored.
During a January 2015 eight-day hospitalization (2 heart attacks in 3 days, then pacemaker/ICD operation on day 5), I was only sedated during the 2 back-to-back angioplasties, but no sedation during recovery. It was only when it came time for the pacemaker and heart wires to go in that I was heavily sedated and slept well for some of that night. It seems that unless there is an operation, a heart attack patient is on their own. It was the industrial metallic clatter of my hospital room door latch that was causing me serious upset by the 4th day.
I wasn’t in ICU, just on the cardiac floor, but medical and other staff were coming in almost hourly 24/7 and the ‘BLAM!’ of the latch startled me badly… it went on night and day, so I wasn’t able to sleep night and day. Only one sharp night nurse observed I was never asleep when she entered during the wee hours. I said ‘You’re looking at a PTSD lady and check out the sound that door latch makes when staff goes in and out”. She said, ‘Oh wow, that sounds like a gun shot. Metal on metal clang’. I said, “Yes, these are instituional latch hardware that have no place in a cardiac ward. THere are whisper soft door closures available’.
Back home, I hit the bed fast. The surgery healed at an expected slow rate. The PTSD from 8 days of BLAM BLAM BLAM stayed at extremely high levels for over a month before beginning to calm down. My cardio has now deemed it ‘irritable heart’, a term that arose with Gulf War veterans.
If you are interested, I highly recommend the PBS episode: A MATTER OF DUTY; THE CONTINUING WAR AGAINST PTSD.
Kennebec County Sheriff Randall Liberty, an Iraq War PTSD veteran himself, initiated the segregation of a prison wing to house only war vets w PTDS together… with a focus on getting rid of triggering mechanisms like clanging metal doors for starters. The success has been remarkable and it is the only wing with no shouting, acting out. A spate of military dogs dying of heart attacks after multiple deployments without recovery time also helped bring out the potentially deadly impact of PTSD.
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Thanks so much, Jaynie. I consider you a walking, talking encyclopedia of very credible knowledge on All Things Cardiac, so I take your kind compliments gratefully! Thanks for that PBS suggestion – I’ll go look it up. Also, your BLAM BLAM BLAM story reminds me of 15-year old patient Morgan Gleason and her right-on rant about noise in hospitals!! Some hospital staff, however, simply have NO FREAKIN’ CLUE about how disruptive and downright dangerous to healing that such relentless noise can be! “Sounds like a gunshot!” should have been that nurse’s first hint to call the hospital facilities staff and get that addressed once and for all. I swear, until the hospital CEO gets a turn being the one lying helpless and frightened in that bed, few things will change unless we risk being the “difficult patient” and rattle a few cages ourselves…
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A-fib can also cause PTSD, with every palpitation, doctor appointment, and anti-coagulation clinic visit a trigger. The best thing about a successful ablation is that it reduces, if not eliminates, these triggers.
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And that’s only if the ablation is indeed successful – for many, it is not. More stress, more anxiety, more triggers. Thanks, Genevieve…
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Right on again, Carolyn: The psychological issues following my heart attack were all absorbing. Being hyper vigilant to begin with (hence fibromyalgia) PTSD found its way into my repertoire very quickly. Waiting for the next HA to happen that first year was hellish for all around me. Cognitive Behavioural Therapy, Mindfulness Meditation, talk therapy and YOU helped me greatly.
Ironically, just recently, with sciatica and great pain in leg and buttocks I have focused more on that and it has helped forget a little about my heart issues:-). Not that heart disease is ever out of mind!
My first visit to the family doc after the HA, I was greeted with: “You’re fixed now, get on with it”. Now that helped a lot, ha!
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You raise such an important point, Barbara: how worse pain can distract us from chronic pain. When I twisted my knee recently, the resulting excruciating pain and swelling made my daily ongoing chest pain almost imperceptible! It’s like that old joke about no trouble being so bad that it can’t be minimized by wearing shoes that are two sizes too small. (Not recommended… )
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I already had depression and anxiety, prior to my heart attack. Since then I have become a hypochondriac and my anxiety levels were off the charts. It took my Primary Care Provider to recognize my state and get me on an anti-anxiety medication. That medication has kept me out of the ER every other month. The Cardiology Team had no clue, as long as my heart studies were good, they figured I didn’t have a problem.
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Elizabeth, you might be interested in this (from cardiac psychologist Len Gould): “The emotional impacts of a cardiac event have a greater impact on patients than the physical impacts.”
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Thank you, Carolyn.
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When I spoke to cardiac rehab and cardiologist about my PTSD symptoms, they pooh-poohed me. The message was, “you’re alive, just get on with it.” I think all cardiac patients should routinely be offered therapy.
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I agree, Anne! Ideally, this therapy should start while still in CCU before discharge in order to acknowledge the under-appreciated psychosocial fallout that a cardiac diagnosis so often brings.
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Oh my! Compassion and understanding from the doctors? I think I had a bit of this after my left main bypass. I had a graft failure but for me I was told “you are not exercising, you must not be eating right, “ and my favorite ” you must be over sensitive, I bet you also feel your ovaries when you ovulate”.
I think the medical field created PTSD in me because it took 8 years to fix the problem that they created after they saved my life. It took a while to find a fabulous cardiologist but I now have a stent placed and feel great. (and now I am overweight and don’t exercise because I couldn’t for so many years. I am working on that).
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So glad you found your current cardiologist and are feeling great, Jennifer. I read recently about the concept of abandonment as a factor in later PTSD, which makes sense for those of us who were misdiagnosed by the very people we sought out to help us.
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Abandonment is a helpful concept in understanding anger and distress when those you look to (and need) for help dismiss and discount our reports. When we are fighting for our lives and persistence only makes them more adamant.
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Yes, that concept helps to explain a lot, doesn’t it? In this 2010 post, I wrote about Dr. Frank Ochberg, a founding board member of the International Society for Traumatic Stress Studies, who wrote about feeling abandoned by our family/friends: “Sometimes the responses from others you rely on for support are negative. For example, someone may play down your problems, needs or pain, or expect you to recover more quickly than is realistic. This is strongly linked to long-term distress in trauma survivors.”
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