Posttraumatic stress syndrome (PTSD) occurs as a result of experiencing or witnessing a life-threatening event. It is estimated that about eight million people experience posttraumatic stress syndrome. There is increasing evidence of the connection between PTSD and heart disease. While most commonly associated with those who have served in combat, anyone who has been involved in a car accident, a natural disaster, sexual assault or other major dramatic event may be a PTSD candidate. This includes those who have experienced health issues, including stroke, heart attack or other cardiovascular conditions.
Everyone reacts to traumatic incidents differently but there are symptoms which lead to a PTSD diagnosis if they continue for longer than one month. These symptoms include reliving the event through nightmares or flashbacks. Other signs include reacting to something that triggers vivid memories such as a smell, sound or image. Avoiding certain situations, negative changes in personal beliefs and a continual feeling of anger, being jittery or “on edge” may also signal PTSD. Additionally, the development of difficulty in sleeping or concentration could be symptomatic.
Specific cardiovascular risks
There are several notable risk areas for the appearance of PTSD among those who have experienced cardiovascular events. Fifteen- to twenty-five percent of those who have heart attacks and strokes are susceptible to a later diagnosis of PTSD. Having PTSD doubles a heart patient’s chances of suffering another heart attack.
PTSD can also increase blood pressure and heart rate. According to the National Stroke Association, about 300,000 survivors of stroke develop PTSD every year. Symptoms can appear within the first year of the stroke or after the first year mark.
The American Heart Association (AHA) reports that survivors of aortic dissection, a life-threatening condition brought upon by a tear in the aortic wall, often develop PTSD. In an aortic dissection, blood rushes between the aorta’s walls causing a sharp pain that often extends from the chest to the back. This is usually treated with surgery and medication and leaves a lasting emotional response. The PTSD associated with aortic dissection can appear years after the incident.
The development of PTSD can also increase the risk of atrial fibrillation (AFib), the most common type of irregular heartbeat. With AFib, the heartbeat does not move blood properly from the heart’s upper chamber, the atria, to the lower chambers, called ventricles. Untreated, AFib can lead to stroke.
Managing PTSD and heart disease
The reasons that PTSD can be so dangerous to those with cardiovascular issues go beyond the obvious physical implications. If the PTSD brings stressful situations to mind, the body reacts. Mere thoughts of the past trauma can cause an increase in heart rate, blood pressure and anxiety, already a danger for those who have dealt with heart attack or stroke. In addition, the person experiencing the anxiety may avoid taking medication because of the memory it brings to the life-threatening cardiovascular event. Avoiding medication could lead to another heart attack or stroke.
Treatment of PTSD itself may involve psychotherapy or counseling. Techniques such as trauma-focused psychotherapy explore the meaning of the traumatic event. Another method known as EMDR (eye movement desensitization and reprocessing) utilizes sound and hand motions to help process the moment of anxiety. Medications are also available that have been effective. Among them are certain selective serotonin reuptake inhibitors (SSRI) or serotonin-norepinephrine reuptake inhibitors (SNRI), also used in combating depression.
It is important for those who have had heart attacks and strokes to alert their cardiologist if any symptoms of PTSD occur. The cardiologist can more accurately develop a treatment plan with the patient that will coordinate the management of the PTSD and the cardiovascular issue.
To learn more about managing PTSD and cardiovascular disease, log on to vascularhealthclinics.org.