Issue link: https://viewer.e-digitaledition.com/i/100763
cliNical featuRe No Relief for Some Heart Attack Survivors posT-TraumaTic sTress disorder (pTsd) iniTiaTed by a cardiac evenT, such as a hearT aTTack, may precipiTaTe a second evenT, according To recenT sTudies. A utHoRS of a June 2012 study published by PLoS ONE, led by Donald Edmondson, Ph.D., assistant professor of behavioral medicine at the Center for Behavioral Cardiovascular Health at Columbia University, found a 12% prevalence rate of PTSD caused by an acute cardiovascular syndrome (ACS), such as myocardial infarction or unstable angina, in 48 studies dating back to 1994. The study also found that PTSD caused by an initial cardiovascular event approximately doubled the risk for a repeated cardiac event or death. doubling the Risk of Recurrence According to statistics compiled by the American Heart Association, the Centers for Disease Control and Prevention, and the National Institutes of Health, 610,000 people in the United States suffer their first heart attack every year. The PLoS ONE study, titled ���Posttraumatic Stress Disorder Prevalence and Risk of Recurrence in Acute Coronary Syndrome Patients: A Meta-Analytic Review,��� suggests 73,200 of these patients will develop PTSD following their initial heart attack. ���If you���re looking at a patient and evaluating how this person is doing after a heart attack ��� any concerns you may have about them going forward ��� let depression and PTSD both come to mind,��� says Dr. Edmondson. ���If depression is not happening, then PTSD very well may be.��� Through physiological and behavioral pathways, PTSD leads patients to increased risk for recurrent cardiac events, says Dr. Edmondson. PTSD causes increased autonomic nervous system activity, which is responsible for the ���fight or flight��� mechanism. Reminders of the initial heart attack may prove unavoidable for patients who have developed PTSD. Meeting with increased autonomic activity, each intrusive thought causes physiologic hyperarousal, resulting in elevated blood pressure and spikes in heart rate, eventually leading to cardiovascular inflammation and atherosclerosis, which lead to hypertension and plaque rupture ��� conditions that contribute to further cardiovascular events. Although only one study has been conducted to examine the efficacy of psychotherapy on patients with heart attack-related PTSD, Dr. Edmondson says prolonged exposure ��� a treatment during which the patient and therapist discuss the traumatic aspects of the heart attack ��� may be able to change how patients react to intrusive thoughts. In an effort to stave off intrusive thoughts, patients may attempt to avoid reminders of their cardiac events. This sounds practical in theory, but when