Posttraumatic stress and heart disease – Dr Barbara Murphy

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Post-traumatic stress disorder (PTSD) is an anxiety disorder that results from exposure to a traumatic event. It is particularly common in war veterans.

PTSD is characterised by intrusive memories, hypervigilance and avoidance of reminder triggers, concentration difficulties, sleep disturbance, and hyperarousal.

 

There is a strong link between PTSD and coronary heart disease. Studies have shown that veterans with PTSD are twice as likely to develop heart disease as veterans without PTSD.

 

What is the link between PTSD and heart disease?

PTSD has been shown to cause reduced blood flow to the heart, known as ischemia, as well as narrowing and hardening of the artery walls, known as atherosclerosis. Both these factors increase the chance of having a heart attack. PTSD is also associated with increases in heart rate, high blood pressure, and arrhythmias. PTSD-positive veterans are also prone to diabetes. Smoking, obesity and social isolation, known risk factors for heart disease, are high in PTSD-positive veterans. Smoking is often used to alleviate PTSD symptoms.

 

Veterans with PTSD have been found to have higher levels of depression than veterans without PTSD. Importantly, depression is associated with both the development of heart disease, as well as early death after heart attack.

 

Unfortunately, veterans with PTSD tend to ignore early warning signs of heart disease and are reluctant to seek treatment for chest pain. This can put them at increased risk of heart attack.

 

Increased risk of depression post-cardiac event in PTSD-positive veterans

Most people experience the ‘cardiac blues’ after a heart attack. This involves feelings of shock, anxiety, worry, guilt, anger and sadness. For most people, these symptoms resolve in the first few months after the heart attack – they are a normal part of recovery.  For PTSD-positive veterans, however, the situation is more complex. Often the cardiac blues do not resolve. PTSD-positive veterans are at increased risk of depression after a cardiac event.

 

Working with cardiac patients who are veterans:

 

  • Be aware that many war veterans have PTSD. Some may not have sought treatment for the PTSD symptoms prior to their cardiac event.
  • These patients are likely to experience a complex emotional recovery after a heart attack or heart surgery due to their pre-existing symptoms of anxiety and depression.
  • Talk to these patients about their emotional wellbeing and undertake a depression risk assessment. If you are worried that a PTSD-positive patient may be depressed, refer them to a mental health specialist for additional specialised support.
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