Until I had a heart attack, I didn’t know that one of the biggest risk factors for having a cardiac event like mine is having already had one. Heart disease, a chronic and progressive diagnosis, is the gift that keeps on giving. And as I wrote here, one of the Big Lessons for me has been that, although my doctors can “squish blockages, burn rogue electrical circuits, and implant lifesaving devices”, their heroic efforts do not address what originally caused this damage to my coronary arteries in the first place – likely decades before my heart attack struck. See also: The Cure Myth
In fact, women are twice as likely to have a second heart attack in the six years following the first compared to our male counterparts.(1) No wonder sobering stats like this can drive the freshly-diagnosed heart patient to an exhausting and fearful state of acute hypervigilance.
Many of us have experienced short-lived hypervigilance after returning home from hospital following our first cardiac event, as I wrote here:
“I was both fatigued and anxious at the same time, convinced by either vague or severe symptoms that a second heart attack must be imminent. I felt a cold, low-grade terror on a daily basis.”
Because of frequent bouts of refractory angina, shortness of breath and crushing fatigue that accompanied my secondary diagnosis of Inoperable Coronary Microvascular Disease, almost every day (sometimes several times a day) – I would often abruptly stop what I was doing, clutch my chest, and ask myself:
“Is this something? Is it nothing? Should I call 911?”
This kind of hypervigilance not only feels exhausting, but it’s a biological state of increased alertness that in itself can be harmful to the body if it becomes chronic. And hypervigilance can also happen even when there is NOT a real, physical danger. Many heart patients can relate to what Len Gould, a cardiac psychologist (and a heart patient himself) likes to say:
“Before a heart attack, every chest pain is just indigestion. Afterwards, every chest pain is another heart attack!”
Dr. Kevin Gilmartin is the author of a book that helped me get through this.(2) His book is called Emotional Survival for Law Enforcement, lent to me by my probation officer-daughter, Larissa. (Stay with me, dear reader – this connection actually makes more sense than you might suspect . . .)
Dr. Gilmartin, who spent 20 years in law enforcement before becoming a behavioural scientist, describes hypervigilance as a very common physiological response that’s inherently useful, basically meant to help increase our odds of survival by enabling the brain to perceive potential threats before we get hurt.
So if you’re out in the woods being tracked by wolves, for example, hypervigilance is a good thing.
But he also says that there are some early warning behavioural signs that hypervigilance is affecting your life:
desire for social isolation
unwillingness to engage in conversations or activities that aren’t related to the “war stories” of your own experiences
reduced interaction with friends and acquaintances
procrastination in decision-making
the “I usta” Syndrome – loss of interest in former hobbies or recreational activities
That last sign is significant, and although listed in Dr. Gilmartin’s work specifically as a common scenario among those working in law enforcement, it can exist among patients living with chronic illness, too.
Dr. Gilmartin describes it as what’s been lost from a person’s life, especially in responding to others who ask about their personal lives. For example:
- “I usta be a runner.”
- “I usta entertain friends and family.”
- “I usta love to read.”
- “I usta garden.”
This “I usta” Syndrome is a generalized effect of hypervigilance. Enjoyable activities that previously defined the complete human being can be lost, as Dr. Gilmartin describes:
“But if these other parts of life are lost, a new person emerges, many times a new person without the balancing strengths of multiple dimensions, activities, or roles in life to draw upon for personal perspective and understanding.”
He now advises his former law enforcement colleagues to be careful in how they identify themselves. Instead of saying, “I’m a police officer”, for example, he suggests: “I work as a police officer.” There’s a subtle but very important difference in those words.
The advice applies to us heart patients, too – especially when we’re feeling anxious about this new role. Instead of identifying ourselves as “I’m a patient”, try saying, “I’m a ______ (fill in the blanks generously: woman, Mum, sister, daughter, knitter, dancer, gardener, reader, writer, bridge player) who happens to be diagnosed with heart disease.”
It reminds us that a diagnosis does not have to define us – which can be hard for a hypervigilant person to believe at the beginning.
The promising news, says Dr. Gilmartin, is that we can actually learn how to become better at becoming emotional survivors – no matter where we are right now. For more on his work, see Are You a Victim or a Survivor?“
One way to start if you’re feeling stuck in a hypervigilant state is to seek talk therapy help from a psychotherapist, pastor, or peer counselor, as Ana Gotter wrote in HealthLine. Through such therapy, you may learn new ways to cope with episodes of hypervigilance and anxiety, including these strategies:
- Be still and take slow, deep breaths.
- Search for objective evidence in a situation before reacting.
- Pause before reacting.
- Acknowledge fears or strong emotions, but don’t give in to them.
- Be mindful.
- Set boundaries with others and yourself.
1. Radovanovic D et al.” Gender differences in management and outcomes in patients with acute coronary syndromes”. Heart. 2007 Nov; 93(11):1369-75.
2. Kevin M. Gilmartin. Emotional Survival for Law Enforcement. E-S Press. 2002.
Q: Do you have your own “I usta” list that has evolved due to hypervigilance?
NOTE FROM CAROLYN: A version of this post originally ran here in June, 2014. I included more about hypervigilance among heart patients in my book, A Woman’s Guide to Living with Heart Disease (Johns Hopkins University Press, 2017).
- How a heart attack can trigger PTSD
- The loss of self in chronic illness is what really hurts
- Squishing, burning and implanting your heart troubles away
- The cure myth
- Where’s the “survivorship” model for heart patients?
- The new country called Heart Disease
- “Everybody has plans ‘til they get punched in the mouth.”
- How we adapt after a heart attack may depend on what we believe this diagnosis means
- Listen up, ladies: 16 things I’ve been meaning to tell you