Heart Attack Fear Leads to Worse Prognosis

Heart Attack Distress as Much Biology as Emotion

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) It's fairly common for patients suffering from a heart attack to experience intense distress combined with a fear of dying. It's almost expected.

But new research recently published in the European Heart Journal suggests that this fairly typical emotional response is also linked to biological changes that occur during acute coronary syndrome (ACS), or the resulting heart attack.

"Keep calm during cardiac events."

These biological changes resulting from fear during a cardiac incident also suggested a worse outcome for patients.

Researchers hoped to pinpoint the association between the intense emotional responses of patients suffering ACS and levels of a cell-signaling molecule – tumor necrosis factor alpha (TNF alpha)  –  that is involved in inducing systemic inflammation.  They also examined whether the emotional response and TNF alpha correlated with indicators of worse biological function equating to a worse prognosis three weeks later.

London researchers assessed the level of distress and fear of dying for 208 acute coronary syndrome patients admitted to St. George's Hospital in London between June 2007 and October 2008. TNF alpha levels also were measured within three days of hospital admission.

Three to four weeks later researchers made a home visit to record heart rate variability (HRV) and the stress hormone cortisol since low levels of cortisol can lead to inflammation. Low HRV indicates that the heart is functioning poorly and can signal future cardiac problems.

Professor Andrew Steptoe, head of the department of epidemiology and public health and British Heart Foundation professor of psychology at University College London said that compared to individuals with little fear of dying, those with intense fear had four times more risk of showing large inflammatory responses.

That same fear also resulted in reduced heart rate variability and alterations in the output of the hormone cortisol in the weeks following a cardiac event.

While the association between the intense emotional responses and higher levels of TNF alpha are not fully understood, they might be part of an integrated biological and emotional response to severe injury to the heart.

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Review Date: 
June 6, 2011
Last Updated:
June 9, 2011