Stress can trigger more heart attacks

Stress can trigger more heart attacks

Reported May 15, 2010

A heart attack can leave people as psychologically traumatized as victims of violence, Canadian research shows.

Reporting in the current issue of the Canadian Journal of Cardiology, the Montreal researchers say post-traumatic stress disorder following a heart attack is an underdiagnosed and unrecognized phenomenon that can put people at risk of another attack.

The researchers found that, one month out, a significant number of heart-attack victims show symptoms of PTSD, such as frequent nightmares or flashbacks, or a constant reliving of the fear, helplessness or horror felt when they were having the heart attack and thought they were dying.

“It’s as if you are in a bank and there’s a holdup – you have all those flashbacks that come back into your mind,” said Gilles Dupuis, a professor of psychology at the Université du Québec in Montreal and a researcher at the Montreal Heart Institute.

“They can have trouble sleeping, they can become depressed (or anxious),” he said, adding some study patients had to be interviewed by phone because they were so afraid of returning to the hospital and reliving the memory of the heart attack.

The psychological fallout can have a profound impact on a patient’s recovery, said Peter Liu, a professor of medicine of the University of Toronto and Toronto General Hospital.



Depression alone increases the risk of dying after a heart attack by 20 to 25 per cent, he said.

“For some of these patients, a heart attack is, indeed, a near-death experience,” Liu said.

The stress response can cause not just psychological trauma, but also actual physiological changes – such as increased heart rate and blood pressure – that further harm an already injured heart.

“That’s the last thing you want after a heart attack,” said Liu, a scientific director at the Canadian Institutes for Health Research, which helped fund the study along with the Montreal Heart Institute. “You want the heart to take a rest in order to heal properly.”

For the study, 477 patients hospitalized with a heart attack or myocardial infarction were recruited in three Montreal hospitals between June 2002 and April 2005. Patients were met at the hospital at least two days after the heart attack for a first interview, and a second interview took place one month post heart attack.

Structured interviews and questionnaires were used to see how many fit criteria for post-traumatic stress disorder according to the Diagnostic and Statistical Manual of Mental Disorders, psychiatry’s official “bible” of mental illness.

In all, four per cent of the patients had post-traumatic stress disorder, and another 12 per cent met the criteria for a diagnosis of partial PTSD.

Liu said, if anything, the numbers are “probably very conservative” because the researchers were so careful in defining the condition.

“But it will certainly come as a surprise for many people that this is actually present at all in people after a heart attack – and with a pretty high frequency, too,” Liu said.

Risk factors identified in the study included feeling their life was threatened during the heart attack, feeling depressed several days afterwards and a history of seeing a psychiatrist or psychologist.

Women also seemed to be a higher risk for post-traumatic stress disorder following a heart attack than men, but that could simply be because women are more likely than men to report symptoms, Dupuis said.

Source : The Montreal Gazette