In the astute words of the late Irish soccer star, George Best:
“People say you have to hit rock bottom, and I can tell you that almost dying is as rock bottom as it gets.”
When researchers in the U.K. studied hospitalized heart patients, they discovered an interesting association. Intense emotional responses were linked with high levels of a molecule that induces systemic inflammation in the body. Researchers also found that this emotional response correlated with indicators of both worse biological function and worse prognosis three weeks after discharge from hospital compared to heart attack survivors who did not experience an intense fear of dying.
To their surprise, having had a previous heart attack did not influence how frightened the patients were, nor did the severity of the current cardiac event. People who were younger, poorer or unmarried (possibly indicating social isolation) were more likely to have intense fear reactions, the study found.
Professor Andrew Steptoe at University College London explained three key findings of his team’s research:
“We found that, first of all, fear of dying is quite common among patients suffering a heart attack.
“Secondly, fear of dying is not just an emotional response, but is linked into the biological changes that go on during acute cardiac events. Large inflammatory responses are known to be damaging to the heart, and to increase the risk of longer-term cardiac problems such as having another heart attack. We found that, when compared with a low fear of dying, intense fear was associated with a four-fold increased risk of showing large inflammatory responses.
“Thirdly, fear of dying and inflammatory responses in turn predicted biological changes in the weeks following an acute cardiac event, namely reduced heart rate variability and alterations in the output of the hormone cortisol. These processes may contribute to longterm poor outcomes.”
But which comes first? Does the extreme anxiety around suffering heart attack symptoms cause these biological responses, or do the physical symptoms of a heart muscle deprived of oxygenated blood flow cause them?
As I’ve written here and here, I can tell you from personal experience that there are few things in life more anxiety-provoking than being in the middle of a heart attack. This U.K. study was small (about 200 patients, and – as usual – mostly male) but it does “remind us of the connection between the mind and the body”, according to Dr. Suzanne Steinbaum, a preventive cardiologist in New York City:
“This trial shows us that when patients are so fearful, there’s an increase in inflammation and decrease in heartbeat variability, which could lead to poor outcomes.
“So we must address not only the body issues, but the mind issues as well.”
.“We do not know whether helping people overcome their fears would improve the clinical outlook, or whether reducing the levels of acute inflammation would have beneficial emotional effects, but these are possibilities.”.“At the immediate clinical level, we recommend that doctors talk to patients more about their emotional experience when having a heart attack, rather than just concentrating on the physical outcomes. The two are closely linked, and better information and reassurance could be of great benefit.”
“Cardiologists may not be comfortable with ‘touchy-feely’ stuff. They want to treat lipids and chest pain. And most are not trained to cope with mental health issues.”
I’m reminded of a story I heard long ago about a man who collapsed during a serious heart attack while out playing golf one morning with his friends. He was experiencing alarming symptoms of crushing chest pain, he was sweating profusely and had vomited, but was conscious as he lay on the ground waiting for the ambulance to arrive. Everything around him was pure chaos: all he could hear were his friends yelling at him and to each other amid the scream of approaching sirens. His breathing became fast and shallow as a sense of fear and icy panic gripped him. He knew he was dying – right up until a kind bystander knelt down beside him on the grass, took his hand and said to him in a soft, gentle voice:
.“Take a nice big breath and try to stay calm. Help is on the way for you. They’ll be here in just a few minutes, and will take you to the best hospital in the area. Doctors there know exactly what to do to help you get through this. You’ll be in very good hands, and will be cared for by experts who are well-trained and experienced. Just keep breathing, nice and slow…”.
Q: Have you ever experienced a fear of dying during a medical crisis?.
(1) Andrew Steptoe, Gerard J. Molloy, Nadine Messerli-Bürgy, Anna Wikman, Gemma Randall, Linda Perkins-Porras, and Juan Carlos Kaski. “Fear of dying and inflammation following acute coronary syndrome.” European Heart Journal, June 1, 2011.
UPDATE FROM CAROLYN: I wrote more about the fear of dying during a cardiac event n my book “A Woman’s Guide to Living with Heart Disease“ (Johns Hopkins University Press). You can ask for it at your local library or favourite bookshop, or order it online (paperback, hardcover or e-book) at Amazon, or order it directly from my publisher, Johns Hopkins University Press (use their code HTWN to save 30% off the list price).