PTSD after heart problems

What’s on this page

• What is PTSD?
• Causes of PTSD in people with heart conditions
• Role of the brain in PTSD
• PTSD symptoms in people with heart conditions
• How do you know if you have PTSD?
• Treatment for PTSD
• Why treatment for PTSD is important
• Self-help tips for managing PTSD

What is PTSD?

PTSD, meaning post-traumatic stress disorder, is an anxiety disorder that develops after someone has experienced or witnessed a traumatic, distressing event.

After a distressing event, it’s normal to experience overwhelming and unpleasant thoughts, body sensations and feelings. This could include fear, anxiety and a sense that the traumatic event is happening again, which is known as reliving.

But if you notice that these feelings are not lessening over time and they are affecting your daily life, it’s helpful to speak to a GP or trained mental health professional. Sometimes PTSD can develop months, or even years, after the traumatic event.

Asking for psychological support may feel daunting. But it’s important to remember that you are not alone in asking for support.

Taking the first steps to ask for psychological support is the first step to start feeling less overwhelmed and more empowered to seek the options best suited to you.

Causes of PTSD in people with heart conditions

PTSD is often associated with being exposed to events such as military conflicts and road accidents, but it can also develop in people with health problems such as a heart condition.

Having a cardiac arrest, being admitted to an intensive care unit (ICU) in hospital, having heart surgery, or a heart attack or stroke can all lead to PTSD.

You might feel your heart is fluttering and worry you're going to have another heart attack.

There is not one defining heart-related event that can cause PTSD and it’s important for people know that everyone’s experiences are unique to them.

What people with PTSD have in common is that their brain has not been able to process a traumatic event, so that something they have experienced months or even years ago keeps coming up in the present.

This can make it difficult for them to move forward with their future.

Role of the brain in PTSD

The are 3 parts of the brain which are involved in the development of PTSD:

• The amygdala is a pea-sized area of the brain which acts like a fire alarm, warning us when there’s danger and activating our ‘fight or flight’ response. In PTSD, the amygdala is constantly ‘on’, making the person hypervigilant, always looking out for danger.
• The hippocampus, which helps us to recall memories, miscommunicates with the amygdala in people with PTSD. Instead of using memories to help the person remain calm, it brings up previous trauma, making the person think it’s happening all over again.
• The prefrontal cortex, responsible for managing emotions and impulses, also fails to work well with the amygdala and hippocampus, leading to an overwhelming sense of fear.

PTSD symptoms in people with heart conditions

Each person will experience PTSD in their own way. You may experience many or only a few of the following symptoms:

• Hypervigilance: If you have PTSD, your brain is constantly searching for danger, and you may often feel alert or on edge.
• Flashbacks, intrusive thoughts and re-experiencing body sensations: You might experience a bodily sensation like feeling your heart is fluttering and worry you are going to have another heart attack. Or you might have flashbacks of a particular moment during the traumatic event. Sometimes this can be brought on by a trigger such as the sound of an ambulance, going past the hospital you were admitted to, or even smelling or tasting something you ate or drank on the day it happened.
• Avoiding situations: You might avoid doing things that remind you of your experience. For example, you might avoid exercising, even if you know physical activity is good for heart health, because you’re worried about your heart rate going up.
• Nightmares, disrupted sleep and ‘brain fog’: You might find it difficult to concentrate, for example, struggling to watch a TV programme through to the end.
• Changes to your appetite and emotions: Your appetite may increase or decrease as a way of coping. You might feel more easily upset or irritable, angry or fearful. You might develop negative ideas about yourself or the world around you, for example blaming yourself for your heart problems.

How do you know if you have PTSD?

It’s important not to self-diagnose.

It’s normal to experience overwhelming thoughts and behavioural responses to a traumatic event. Your brain is adjusting to something frightening and difficult that has happened.

But if after 4 weeks, these symptoms are not lessening and they are impacting your daily life, it’s a good idea to:

• Speak to your GP, cardiologist, or clinical nurse specialist.
• Or speak to the in-house psychologist working in your cardiac rehab programme or cardiology department, if there is one.

They can help refer you to trained mental health professionals who can give you a formal diagnosis and offer treatment. Or, in England, you can self-refer for therapy.

Treatment for PTSD

You will normally meet a mental health professional for an initial appointment for about 50 minutes.

They will ask about any other pre-existing mental health difficulties, and you will be given a questionnaire to complete about your thinking, feelings and behaviours related to PTSD.

Once you have a formal diagnosis, there are a few treatment options, including medication.

There are 2 main options for treating PTSD, which are recommended by NICE, the National Institute for Health and Care Excellence which sets guidelines for best treatment in the UK:

• Trauma-focused cognitive behavioural therapy (TF-CBT) is a talking treatment for PTSD:
  • It starts with teaching the person about PTSD and trauma symptoms and teaches techniques to calm and soothe.
  • The next stage involves deliberately bringing up distressing memories, working on the beliefs the person has about what happened and helping them make sense of the memories in a different way.
  • The final part focuses on reclaiming things the person used to enjoy doing and doing it in a way that is good for your health.

• Eye movement desensitisation reprocessing (EMDR) is used to reduce the symptoms of PTSD:
  • It works on the model that trauma can be ‘stuck’ or ‘stored’ in the networks in a person’s brain.
  • Rhythmic eye movements are used to reprocess traumatic memories and create new pathways in the brain, so that the memory can be less distressing.
  • It focuses on a past traumatic memory that is currently making the person distressed and helps them develop coping strategies for the future.

You can find out more about TF-CBT and EMDR on the NHS’s website.

You should be given information about the different treatment options and be able to make a choice about which you think will work best for you. The number of sessions can vary. Typically you might have 8 to 12 weekly sessions.

It’s important to realise that these treatments cannot erase the memory of the traumatic event. But they can work to lessen the distress and body sensations you have in response to the memory when it does come up.

Why treatment for PTSD is important

Living with PTSD symptoms can make it difficult for you to get used to your health condition, to get back to work and do the things you used to do before.

It can make it harder for you to do the things that are good for your heart health, such as sticking to your medication, exercising, eating healthily and sleeping well.

Having consistently high levels of the stress hormone, cortisol, in your body is also linked with increased blood pressure and can impact heart health.

People with untreated PTSD are at higher risk of having a heart attack or stroke.

Research has found that people with untreated PTSD are at higher risk of developing heart and circulatory diseases such as atrial fibrillation, stroke, and heart attack, and risk factors such as high blood pressure.

If you’ve already had a major event like a heart attack or cardiac arrest, having untreated PTSD may make it more likely that you’ll have another event. That’s why it’s so important to speak to your GP if you think you have PTSD.

Also, it can sometimes be difficult to tell apart symptoms that can be due to PTSD, such as feeling like your heart is racing, from symptoms related to your heart health.

Psychological treatment can help you to tell the difference, making sure you get the appropriate treatment for both.

Self-help tips for managing PTSD  

While waiting for formal treatment, or alongside formal treatment, there are things you can do to help soothe your PTSD symptoms and build up resilience:

Be kind to yourself and do what you enjoy 

Try to be patient with yourself and treat yourself in a way that is compassionate and kind.

Make space for the things you enjoy doing, whether that’s spending time with loved ones, watching joyful TV or film, listening to music or doing gentle activities such as walking or gardening.

Grounding techniques, such as 5-4-3-2-1

Grounding techniques help bring you back to present, helping to tell your brain that the traumatic experience is not happening again and helping you manage anxiety. A commonly used one, called 5-4-3-2-1, uses your senses. To do this, you look around the room you are in and name:

• 5 things you can see
• 4 things you can touch
• 3 things you can hear
• 2 things you can smell 
• 1 thing you can taste.

You can also do an imagined version of this, called a ‘calm space exercise’. This is where you imagine a place that makes you feel calm, safe and comfortable.

For example, for some people, this might be a beach. You use your 5 senses to imagine what you might see, hear, smell, touch and taste there.

Creating a compassionate box or bag

Another way of quietening down agitated senses is to make a compassionate box or bag full of things that will soothe you.

This could be something with your favourite scent, something with a taste you enjoy, such as a mint, something that lets you listen to your favourite music, and perhaps a postcard or picture that transports your mind to a calm place.

You can use this bag or box to calm you at any time of day or night.

Breathing techniques

When you are feeling anxious, you tend to take shallow, gulping breaths. Techniques such as box breathing or the 4-7-8 can help to slow your breath down and calm your mind.

Journal writing

Writing down what you are feeling and thinking can help you to express what you experienced.

Writing can help you to release difficult thoughts and feelings but it can also be helpful to write positive thoughts or affirmations that can help you to feel better.

Connecting with other people

Being part of a group of people who have gone through similar experiences to you can allow you to share stories, thoughts and feeling and this can aid in recovery.

This could mean connecting with people who are in cardiac rehab with you or finding a local heart support group.

More information and support

• See PTSD UK and the Royal College of Psychiatrists for more information on symptoms and treatment.
• Visit Mind or call their helplines for mental health support.
• Join our online community on Health Unlocked to talk to other people with heart conditions. 

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