Distress, Fear often Beset Heart Attack Patients

NEW YORK (Reuters Health) – A substantial number of
patients in the initial stages of a heart attack or severe
chest pain crisis — events lumped together as “acute coronary
syndrome” or ACS — experience extreme stress and fear of
dying. This can lead to long-lasting depression and anxiety,
according to a new study.

“Experiencing an ACS may provoke a range of negative
emotional responses, including acute distress and fear of
dying,” Dr. Andrew Steptoe and colleagues from University
College London, UK, write. “The frequency of these emotional
states has rarely been assessed.”

To investigate, the researchers studied 184 patients with
ACS, along with the correlates and consequences of their
emotional states.

Forty patients (22 percent) reported intense distress and
fear of dying, Steptoe’s group reports in the American Journal
of Cardiology. Ninety-five (52 percent) patients reported
moderate distress and fear.

Intense distress and fear was associated with female
gender, lower levels of education, greater chest pain, and
emotional upset in the two hours before ACS onset.

Patients who exercised regularly were less likely to have
acute distress or fear. Having no distress or fear was also
more common in patients who did not at first attribute their
chest pain to cardiac causes.

Acute distress and fear of dying predicted greater
depression and anxiety levels a week after the ACS, and high
levels of depression three months later.

The factors that trigger depression after a heart attack
“differ in several respects from those for depression in
general,” Steptoe’s team notes. “Greater understanding may
accrue from more precise delineation of the trajectory of
emotional responses, including factors preceding symptom onset,
acute fear and distress during the early symptomatic phase, and
later development of depression and anxiety.”

SOURCE: American Journal of Cardiology, December 2005.