Heart Attacks and PTSD: A Vicious Cycle

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Gary Dorman of Hillsdale, N.Y., thought he had a bad case of holiday indigestion one morning after Christmas more than a decade ago.

When sweat started pouring off of him during his morning routine, he realized, "I'm having a heart attack" -- and proceeded to collapse.

Paramedics rushed him to the hospital, where doctors diagnosed and treated him for a major heart attack. Dorman survived this initial episode, as well as three subsequent surgeries to place stents and implant a defibrillator into his chest.

Physically, Dorman recovered from his heart attack and the operations. Mentally and emotionally, it was a different story.

"I went through a period of depression," said Dorman, now 64. "I was becoming non-functional. I didn't enjoy anything in the world.

"Sleeping is a big problem," he added. "You stub your toe and think it's a heart attack. My blood pressure is high on a good day."

Today, Dorman lives with Post-Traumatic Stress Disorder, or PTSD for short. PTSD is a type of anxiety that can occur after experiencing a traumatic event that threatens serious injury or death. Sufferers experience nightmares, high blood pressure and an increased heart rate. Often, they live in fear of things that would remind them of the initial traumatic event.

PTSD is usually associated with war, assault, abuse and violence -- but new research suggests that heart patients also battle this disorder.

Donald Edmondson, a professor of behavioral medicine specializing in cardiovascular health at Columbia University Medical Center in New York, led a study examining the relationship between heart attack and PTSD. This review of 24 studies involved more than 2,000 patients, and revealed that one in eight heart patients develop significant symptoms of PTSD.

Considering the fact that 1.4 million Americans are hospitalized for cardiac events each year, the findings suggest a substantial portion of the population may be living with psychological trauma and not realize why.

"I became interested in the relationship between PTSD and heart attacks after watching my patients," Edmondson said. "Once the physical threat is over, the family is ready to move on. But for the patients themselves, it's not over with. It's with them every day. "

Dorman, who had to stop his work in the printing industry because of his heart condition, said that before suffering his heart attack at age 52, he enjoyed being a competitive squash player, scuba diver and gardener.

"That all changed after the doctor told me I wasn't ever going to work again," Dorman said.

"Slowly but surely, this thing has robbed me of everything I loved," he said. "My marriage broke up. I can't do my old hobbies. Some days, I feel like a cardiac cripple."

Worse, the new analysis also suggests that heart patients who suffer PTSD face twice the risk of having another cardiac event -- or even dying within one to three years -- compared to patients without psychological symptoms.

"Heart attacks can be dramatic events," said Dr. Redford Williams, director of the Behavioral Medicine Research Center at Duke University in Durham, N.C. "It's not unlike what it is like for a soldier when a bombs goes off. You know something is terribly wrong, you might die and you cannot control it.

"It's no surprise that heart attack patients develop PTSD, and that it increases their chance of having yet another attack," Williams said.

Fortunately, things improved for Dorman. Although initially reluctant to see yet another doctor or take another pill, he was eventually prescribed an antidepressant -- a medication that he said improved his life immensely. Psychological therapy is another safe and effective option for some heart attack patients.

Doctors hope that knowing about the specific relationship between heart attack and PTSD will continue to improve treatment for better mental and physical health.

"We can't intervene on the battlefield to prevent soldiers from getting PTSD," Edmonson said. "But there may be things we can do to help protect our patients."