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How PTSD can trigger non-adherence to heart medication & treatment following a heart attack

Mar 31, 2024

Living with post-trauma stress (pts) following a life-threatening event such as a heart attack or stroke, often involves experiencing stress, anxiety and depressive symptoms. Life can be debilitating and overwhelming with people finding it difficult to function at work, home, leisure, and in social & intimate situations. Much of the time it's hard to focus on being in the present when reliving events from the past.

Research suggests 1 in 8 of us who are in that position of experiencing a heart attack or stroke will develop a post-trauma stress response afterwards. The more we perceive our life to be in danger due to our symptoms, the more out of control we feel, and the more likely we are of experiencing pts. What's more, research also suggests that those who develop post-trauma stress are about twice as likely to die from another heart attack within the next one to three years.  

Post-trauma stress could happen for anyone at anytime following an incident sufficient enough to induce a fear response triggered by perceptions or a reality that our life, or that of someone else's, is in danger. During these moments we're likely to feel frightened, helplessness and ultra aware of bodily feelings we don't feel we have control of.   

This gets carried over to the pts response where we might continue to experience high levels of arousal, especially when unable to avoid triggers associated with the trauma such as when having flashbacks to the trauma event during sleep.  During these moments of overactivity of the sympathetic nervous system our heart beats faster and for prolonged periods. 


Survivors can continue to relive certain aspects of their trauma event for some time afterwards either in conscious state or during sleep in the form of nightmares or dreams. For example what happened during the trauma event, the process of getting help, having treatment and/or surgery. Depending on the time, day, method of how they arrived at the hospital, and even the nature of the treatment they received, each persons experiences will be very unique and will influence the deep and lasting emotional and cognitive responses that they might fixate on later as part of experiencing post-trauma stress syndrome.  

Being a heart or stroke patient means there will be several arousal triggers reminding them of their trauma. These are likely to increase arousal even in people with milder symptoms of pts, such as receiving appointment letters or texts, blood tests, blood pressure checks, driving licence renewal, needles, medication packaging, etc.  

In order to manage the arousal and prevent re-experiencing of the trauma, survivors will typically find ways to self-regulate to prevent arousal from happening. One common early method of doing this is to use avoidance strategies, including repressing the memories from consciousness i.e., not remembering what happened, or suppressing them when they do surface such as getting busy and using mood altering substances such as drugs or alcohol. 


Whilst these are important early steps and very functional strategies for helping people with pts to feel safe and recover, if used over the longer term they can prolong the duration of negative symptoms, have detrimental effects in preventing recovery longer term, trigger further heart attacks, and increase anxiety & stress by missing appointments and/or not adhering to critical medication or self-care regimes.


Recovery from post-trauma stress syndrome involves two important elements crucial to preventing further cardiovascular damage: one, eliminating high levels of arousal due to flashbacks which can significantly increase the risk of having another heart attack or stroke; and two, reducing avoidance, which if left unmanaged can trigger non-adherence to treatment and medication. If not treated appropriately using psychotherapy and/or psychotropic medication, both of these elements can leave the survivor vulnerable to further heart attacks or strokes leading to further decline in their mental and physical health and well-being.


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