Post-Traumatic Stress Symptoms After a Heart Attack

Did you know that a large percentage of patients experience post-traumatic stress disorder after a heart attack? In this article, we're going to examine the elements behind this association.
Post-Traumatic Stress Symptoms After a Heart Attack
Gorka Jiménez Pajares

Written and verified by the psychologist Gorka Jiménez Pajares.

Last update: 26 March, 2023

Today, increasingly more disorders are linked to lifestyles. For instance, stress is considered to be a serious public health problem. In fact, despite the ravages caused by the pandemic, cardiovascular diseases (CVD), such as heart attacks, continue to be one of the main sources of death in developed countries.

In Europe, every year, cardiovascular disease (CVD) causes 3.9 million deaths. Indeed, it’s the leading cause of death in the EU. While in the US, one person dies every 34 seconds from cardiovascular disease.

According to the American Psychiatric Association, post-traumatic stress disorder (PTSD) is a clinical entity that describes people who’ve been exposed to a life-threatening situation. This is compatible with being a heart attack survivor.

“PTSD is a disorder that can develop after exposure to an extremely threatening event or series of events.”

-World Health Organization-

sad senior man
According to science, there are several psychosocial factors that affect the evolution of a heart attack.

Psychosocial factors: the triggers that produce heart attacks

There’s a great deal of research that describes the influence of various psychosocial factors in the evolution of a heart attack. It includes increased stress, the product of a ‘galloping’ lifestyle in which everything seems to go extraordinarily fast. It also includes the pressure that individuals suffer as a result of their work situation and the economic stress experienced after a constant rise in prices.

In addition, relationships have been found between personality factors (such as hostility) and these diseases. For example, patients with a tendency to hostility are more prone to having a heart attack. Also more at risk are individuals with a Type D personality (Jackson et al., 2018).

As a consequence of these factors, subjects experience a greater number of negatively valenced emotions. Depression and anxiety are two of the clinical entities that most correlate with CVD. In fact, they act as the spark that lights the fuse of a heart attack. They also significantly affect its course (how it progresses) and its prognosis (whether the condition will resolve effectively or develop complications).

Meta-analyses are defined as analyses of analyses or studies of studies. They constitute one of the most sophisticated ways of obtaining scientific evidence. This is because they ‘create’ science via the scientific results themselves. The results of meta-analyses in this regard unequivocally indicate that psychosocial factors are associated with the course and prognosis of infarctions (Castilla et al., 2022). As Murielle (2022) states:

“Post-traumatic stress disorder (PTSD) is associated with a significant increase in subsequent onset of heart attack, and hospitalizations for heart attack or cardiac mortality.”

-Murielle Jacquet-Smailovic-

Post-traumatic symptoms after a heart attack

After suffering a heart attack, patients often report experiencing post-traumatic stress symptoms. However, although their association with a CVD prognosis has been demonstrated, liaison cardiology or psychology professionals (and other professionals) often pay little attention to these symptoms. This lack of attention has been shown to increase the probability that, in the future, the patient will be readmitted due to other heart attacks.

As we mentioned at the beginning of the article, a heart attack is a situation that endangers a patient’s life. This meets the definition of the situation given by the American Psychiatric Association. Moreover, it’s common for patients in a post-infarction situation to experience acute stress symptoms in the weeks following the event. If acute stress symptoms continue for more than a month, PTSD may be diagnosed.

From a clinical point of view, carrying out an evaluation of the subject’s mental state immediately after the infarction is important (Castilla et al., 2022). The exact biological mechanisms linking stress and mortality after CVD are still unknown. However, it’s suggested that an increase in inflammation could occur. Furthermore, there could be poor adherence to drugs and unhealthy lifestyle habits.

man with a heart attack
According to Murielle Jacquet-Smailovic, the prevalence rate of PTSD related to acute coronary events is almost twice the rate as in the general population.

What elements predict post-traumatic stress symptoms after a heart attack?

There are several candidates to be considered as predictors of post-traumatic symptoms after a heart attack. According to the researcher Cristina Castilla, the following have been identified:

  • Being young.
  • Low socioeconomic level.
  • Being a woman.
  • Having the perception of a ‘loss of control’.
  • Suffering from depression at the time of the heart attack.
  • Possessing a psychiatric history.
  • Having a lack of social support.
  • Perceiving the heart attack as an ‘extremely serious’ event.
  • Attributing the heart attack to themselves. For example, “It happened because I didn’t take care of my health”.

Scientific evidence indicates that people who’ve suffered a heart attack and, as a result of it, develop a negative affective state tend to develop symptoms of post-traumatic stress. This happens because they consider the event as “extremely serious”. Moreover, they often attribute it to themselves (“It’s my fault”).

As you can see, it’s imperative that healthcare professionals involved in the recovery and rehabilitation of patients who’ve suffered a heart attack pay attention to acute and post-traumatic stress symptoms. Therefore, correct evaluations are essential. In addition, intervention protocols should be developed that delimit and lessen these symptoms.

“The self-perceived severity of the infarction is directly related to the severity of the post-traumatic symptoms associated with the coronary event.”

-Cristina Castilla-

All cited sources were thoroughly reviewed by our team to ensure their quality, reliability, currency, and validity. The bibliography of this article was considered reliable and of academic or scientific accuracy.

  • American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (Dsm-5-Tr(tm)) (5.a ed.). American Psychiatric Association Publishing.
  • CIE-11. (s. f.).
  • Peña Coto, C., Ramírez Muñoz, J., & Castro Vargas, F. (2012). Infarto agudo del miocardio por estrés laboral. Medicina Legal de Costa Rica, 29(2), 111-1190.
  • Jackson, C. A., Sudlow, C. L., & Mishra, G. D. (2018). Psychological distress and risk of myocardial infarction and stroke in the 45 and up study: A prospective cohort study. Circulation: Cardiovascular Quality and Outcomes, 11(9).
  • Jacquet-Smailovic, M., Brennsthul, M. J., Denis, I., Kirche, A., Tarquinio, C., & Tarquinio, C. (2022). Relationship between Posttraumatic Stress Disorder and subsequent myocardial infarction: a systematic review and meta-analysis. Journal of affective disorders, 297, 525–535.
  • Castilla, C., García, F. E., & Vázquez, C. (2022). Causal Attributions and Perceived Severity as Predictors of Posttraumatic Stress Symptoms after a First Myocardial Infarction (Doctoral dissertation, Sociedad Española para el Estudio de la Ansiedad y el Estrés-SEAS.-Colegio Oficial de Psicologos de Madrid (copmadrid)).
  • acquet‐Smailovic, M., Tarquinio, C., Alla, F., Denis, I., Kirche, A., Tarquinio, C., & Brennstuhl, M. J. (2021). Posttraumatic stress disorder following myocardial infarction: a systematic review. Journal of Traumatic Stress, 34(1), 190-199.
  • Johnson, J., & King, K. (1995). Influence of expectation about symptoms on delay in seeking treatment during myocardial infarction. American Journal of Critical Care, 4, 29-35.

This text is provided for informational purposes only and does not replace consultation with a professional. If in doubt, consult your specialist.