Fear of dying during heart attack

LaundryQueen

Fear of Dying During Heart Attack May Make Matters Worse.
High anxiety linked to greater inflammation, study finds
By Amanda Gardner / HealthDay Reporter

WEDNESDAY, June 1 (HealthDay News) -- People who become very afraid of dying in the moments during and days after a heart attack also seem to have more inflammation, an indicator that they may, in the long run, do worse than patients who are less fearful, a small British study suggests.

The finding, published online June 1 in the European Heart Journal, "reminds us of the connection between the mind and the body," said Dr. Suzanne Steinbaum, a preventive cardiologist with Lenox Hill Hospital in New York City.

"This trial shows us that when patients are so fearful, there's an increase in inflammation and decrease in heartbeat variability, which could lead to poor outcomes. So we must address not only the body issues but the mind issues as well," she said.

Added Dr. Robert Gramling, associate professor of family medicine at the University of Rochester Medical Center in New York: "This and the vast literature related to emotions and mind/body interactions are confirmatory that understanding people's emotional response does interplay with the biologic mechanisms. I believe, yes, attending to emotions is extraordinarily important, not only for the well-being of the individual's emotional and mental health but also for physical health and maybe even evolution of myocardial infarction [a heart attack]."

For the new study, researchers assessed 208 patients who had come to St. George's Hospital in London with acute coronary syndrome -- blockage of the coronary arteries -- during an 18-month time frame. They were asked during their hospital stay about their fear of dying. At the same time, the researchers also measured blood levels of tumor necrosis factor (TNF), which is involved in triggering inflammation.

Three weeks later, the researchers visited patients in their homes and measured heart rate variability and levels of the stress hormone cortisol in the saliva.

One in five patients reported feeling extreme distress and fear of dying, while two-thirds experienced more moderate emotional reactions. People who were younger, poorer and unmarried (possibly indicating social isolation) were more likely to have intense reactions, the study found.

Fear of dying was associated with a fourfold increase in TNF levels at time of admission to the hospital. Three weeks later, TNF levels were found to be linked with lower heart rate variability and lower cortisol levels.

Lower heart rate variability levels have been linked with higher death rates after a heart attack, while lower cortisol levels may indicate that the body isn't able to quell the inflammation caused by a heart attack.

To the researchers' surprise, having had a previous heart attack didn't influence how scared the patients were.

The study does have some limitations, including the fact that some 23 percent of the patients dropped out after three weeks; there were few women; and most patients had STEMI (ST-elevation myocardial infarction), the more severe type of heart attack, meaning that the findings can't really be extrapolated to non-STEMI heart attacks.

"It's a very small study, it's predominantly those with STEMI heart attacks and, most of the patients, we don't know all the clinical information," said Dr. Stephen Green, associate chairman of cardiology at North Shore University Hospital in Manhasset, N.Y.

Nor does the study answer the "chicken-and-egg" question of whether emotional distress caused the biological findings or vice versa.

"The study provokes a lot of thoughts in terms of what physicians should do with patients and what patients should do for themselves and [directions for] future research. [But] it's just a beginning in my mind and something that we shouldn't translate into changing our practices at this point," Green said.

Tethys41

Makes sense
This study makes a lot of sense to me. I would bet fear affects the outcomes of many ailments. Fear triggers numerous responses in the body that causes stress to the organs. Clearly, in the absence of fear, the body should be better able to recover from anything.

carolenk

Tethys41 said:

Makes sense
This study makes a lot of sense to me. I would bet fear affects the outcomes of many ailments. Fear triggers numerous responses in the body that causes stress to the organs. Clearly, in the absence of fear, the body should be better able to recover from anything.

This could explain why my
This could explain why my mom survived a heart attack several years ago when she chose not to go to the ER or even call 911. She told me that she woke up at 5 am with crushing chest pain and was thinking, "I guess this is it, the end, people are are gonna think I died peacefully in my sleep but this really hurts!"

She wasn't afraid to die at all but she didn't want to found dead without her dentures in. So she got up to put her teeth in and the chest pain eased up and went away. She never told anyone about the chest pain incident until after the evidence of the heart attack was found on a routine EKG.

Was it FDR who said, "...the only thing we have to fear is fear itself..."?

Mwee

makes sense
and I also think patients with positive outlooks respond better.
(((HUGS))) Maria

carolenk

Mwee said:

makes sense
and I also think patients with positive outlooks respond better.
(((HUGS))) Maria

Accepting your fate
@Maria--I wouldn't say my mom even has that much of a positive outlook so much as she has a kind of fatalistic outlook. Sort of "whatever will be, will be."

My mom has been treating herself for a squamous cell skin cancer on her face for YEARS! She refuses to have it treated by a doctor. I gave up on trying to get her to have surgery. I don't know what she did that worked--could have been using the hair dryer on it but it looks like it's GONE! I keep expecting it to come back...

Carolen