Skip to main content
SpringerLink
Log in

Symptom experience during acute coronary syndrome and the development of posttraumatic stress symptoms

  • Published:
Journal of Behavioral Medicine Aims and scope Submit manuscript

Abstract

There is growing evidence for the development of posttraumatic stress symptoms as a consequence of acute cardiac events. Acute coronary syndrome (ACS) patients experience a range of acute cardiac symptoms, and these may cluster together in specific patterns. The objectives of this study were to establish distinct symptom clusters in ACS patients, and to investigate whether the experience of different types of symptom clusters are associated with posttraumatic symptom intensity at six months. ACS patients were interviewed in hospital within 48 h of admission, 294 patients provided information on symptoms before hospitalisation, and cluster analysis was used to identify patterns. Posttraumatic stress symptoms were assessed in 156 patients at six months. Three symptom clusters were identified; pain symptoms, diffuse symptoms and symptoms of dyspnea. In multiple regression analyses, adjusting for sociodemographic, clinical and psychological factors, the pain symptoms cluster (β = .153, P = .044) emerged as a significant predictor of posttraumatic symptom severity at six months. A marginally significant association was observed between symptoms of dyspnea and reduced intrusive symptoms at six months (β = −.156, P = .061). Findings suggest acute ACS symptoms occur in distinct clusters, which may have distinctive effects on intensity of subsequent posttraumatic symptoms. Since posttraumatic stress is associated with adverse outcomes, identifying patients at risk based on their symptom experience during ACS may be useful in targeting interventions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Notes

  1. 2-step cluster analysis, auto-clustering solution for first 5 solutions: 1 cluster; BIC 4419.161: 2 clusters; BIC 4138.803, BIC ratio of change 1.000, Ratio of distance 1.360: 3 clusters; BIC 3952.190, BIC ratio of change .666, Ratio of distance 1.793: 4 clusters; BIC 3880.778, BIC ratio of change .255, Ratio of distance 1.154: 5 clusters; BIC 3828.742, BIC ratio of change .186, Ratio of distance 1.047.

References

  • Abbas, C. C., Schmid, J. P., Guler, E., Wiedemar, L., Begre, S., Saner, H., et al. (2009). Trajectory of posttraumatic stress disorder caused by myocardial infarction: A two-year follow-up study. International Journal of Psychiatry and Medicine, 39, 359–376.

    Article  Google Scholar 

  • ACC/AHA. (2007). Guidelines for the management of patients with unstable angina/non–ST-elevation myocardial infarction. Journal of the American College of Cardiology, 2007(50), 652–726.

    Google Scholar 

  • Ammann, P., Pfisterer, M., Fehr, T., & Rickli, H. (2004). Raised cardiac troponins. British Medical Journal, 328, 1028–1029.

    Article  PubMed  Google Scholar 

  • Association, American Psychiatric. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association.

    Google Scholar 

  • Bech, P. (2010). Struggle for subtypes in primary and secondary depression and their mode-specific treatment or healing. Psychotherapy and Psychosomatics, 79, 331–338.

    Article  PubMed  CAS  Google Scholar 

  • Beck, A. T., & Steer, R. A. (1987). Beck depression inventory manual. Toronto: Ontario: Harcourt, Brace, Jovanovich.

    Google Scholar 

  • Beutel, M. E., Bleichner, F., von Heymann, F., Tritt, K., & Hardt, J. (2010). Anxiety disorders and comorbidity in psychosomatic in-patients. Psychotherapy and Psychosomatic, 79, 58.

    Article  Google Scholar 

  • Caldwell, M. A., & Miaskowski, C. (2000). The symptom experience of angina in women. Pain Management Nursing, 1, 69–78.

    Article  PubMed  CAS  Google Scholar 

  • Canto, J. G., Shlipak, M. G., Rogers, W. J., Malmgren, J. A., Frederick, P. D., Lambrew, C. T., et al. (2000). Prevalence, clinical characteristics, and mortality among patients with myocardial infarction presenting without chest pain. JAMA: The Journal of the American Medical Association, 283, 3223–3229.

    Article  CAS  Google Scholar 

  • Chen, W., Woods, S. L., & Puntillo, K. A. (2005). Gender differences in symptoms associated with acute myocardial infarction: A review of the research. Heart and Lung, 34, 240–247.

    Article  PubMed  Google Scholar 

  • Cohen, H., Benjamin, J., Geva, A. B., Matar, M. A., Kaplan, Z., & Kotler, M. (2000). Autonomic dys-regulation in panic disorder and in post-traumatic stress disorder: Application of power spectrum analysis of heart rate variability at rest and in response to recollection of trauma or panic attacks. Psychiatry Research, 96, 1–13.

    Article  PubMed  CAS  Google Scholar 

  • Dempsey, S. J., Dracup, K., & Moser, D. K. (1995). Women’s decision to seek care for symptoms of acute myocardial infarction. Heart and Lung, 24, 444–456.

    Article  PubMed  CAS  Google Scholar 

  • Dodd, M. J., Miaskowski, C., & Paul, S. M. (2001). Symptom clusters and their effect on the functional status of patients with cancer. Oncology Nursing Forum, 28, 465–470.

    PubMed  CAS  Google Scholar 

  • Doerfler, L. A., Paraskos, J. A., & Piniarski, L. (2005). Relationship of quality of life and perceived control with posttraumatic stress disorder symptoms 3 to 6 months after myocardial infarction. Journal of CardiopulmonaryRehabilitation, 25, 166–172.

    Google Scholar 

  • Doerfler, L. A., Pebert, L., & DeCosimo, D. (1994). Symptoms of posttraumatic stress disorder following myocardial infarction and coronary artery bypass surgery. General Hospital Psychiatry, 16, 193–199.

    Article  PubMed  CAS  Google Scholar 

  • Eagle, K. A., Lim, M. J., Dabbous, O. H., Pieper, K. S., Goldberg, R. J., Van de Werf, F., et al. (2004). A validated prediction model for all forms of acute coronary syndrome: Estimating the risk of 6-month postdischarge death in an international registry. JAMA: The Journal of the American Medical Association, 291, 2727–2733.

    Article  CAS  Google Scholar 

  • Finnegan, J. R., Jr., Meischke, H., Zapka, J. G., Leviton, L., Meshack, A., Benjamin-Garner, R., et al. (2000). Patient delay in seeking care for heart attack symptoms: Findings from focus groups conducted in five U.S. regions. Preventive Medicine, 31, 205–213.

    Article  PubMed  Google Scholar 

  • Foa, E. B., Cashman, L., Jaycox, L., & Perry, K. (1997). The validation of a self-report measure of posttraumatic stress disorder: The posttraumatic diagnostic scale. Psychological Assessment, 9, 445–451.

    Article  Google Scholar 

  • Foa, E. B., Riggs, D. S., Dancu, C. V., & Rothbaum, B. O. (1993). Reliability and validity of a brief instrument for assessing post-traumatic stress disorder. Journal of Traumatic Stress, 6, 459–472.

    Article  Google Scholar 

  • Gander, M. L., & von Känel, R. (2006). Myocardial infarction and post-traumatic stress disorder: Frequency, outcome, and atherosclerotic mechanisms. European Journal of Cardiovascular Prevention and Rehabilitation, 13, 165–172.

    Article  PubMed  Google Scholar 

  • Gift, A. G., Jablonski, A., Stommel, M., & Given, C. W. (2004). Symptom clusters in elderly patients with lung cancer. Oncololgy Nursing Forum, 31, 202–212.

    Google Scholar 

  • Ginzburg, K. (2006). Comorbidity of PTSD and depression following myocardial infarction. Journal of Affective Disorders, 94, 135–143.

    Article  PubMed  Google Scholar 

  • Goff, D. C., Jr., Sellers, D. E., McGovern, P. G., Meischke, H., Goldberg, R. J., Bittner, V., et al. (1998). Knowledge of heart attack symptoms in a population survey in the United States: The REACT Trial. Rapid Early Action for Coronary Treatment. Archives of Internal Medicine, 158, 2329–2338.

    Article  PubMed  Google Scholar 

  • Guler, E., Schmid, J. P., Wiedemar, L., Saner, H., Schnyder, U., & von Känel, R. (2009). Clinical diagnosis of posttraumatic stress disorder after myocardial infarction. Clinical Cardiology, 32, 125–129.

    Article  PubMed  Google Scholar 

  • Horne, R., James, D., Petrie, K., Weinman, J., & Vincent, R. (2000). Patients’ interpretation of symptoms as a cause of delay in reaching hospital during acute myocardial infarction. Heart, 83, 388–393.

    Article  PubMed  CAS  Google Scholar 

  • Johnson, J. A., & King, K. B. (1995). Influence of expectations about symptoms on delay in seeking treatment during myocardial infarction. American Journal of Critical Care, 4, 29–35.

    PubMed  CAS  Google Scholar 

  • Jones, R. C., Chung, M. C., Berger, Z., & Campbell, J. L. (2007). Prevalence of post-traumatic stress disorder in patients with previous myocardial infarction consulting in general practice. British Journal of General Practice, 57, 808–810.

    Article  PubMed  Google Scholar 

  • Kim, H. J., McGuire, D. B., Tulman, L., & Barsevick, A. M. (2005). Symptom clusters: Concept analysis and clinical implications for cancer nursing. Cancer Nursing, 28, 270–282.

    PubMed  Google Scholar 

  • Ladwig, K.-H., Baumert, J., Marten-Mittag, B., Kolb, C., Zrenner, B., & Schmitt, C. (2008). Posttraumatic stress symptoms and predicted mortality in patients with implantable cardioverter-defibrillators: Results from the prospective living with an implanted cardioverter-defibrillator study. Archives of General Psychiatry, 65, 1324–1330.

    Article  PubMed  Google Scholar 

  • Lindgren, T. G., Fukuoka, Y., Rankin, S. H., Cooper, B. A., Carroll, D., & Munn, Y. L. (2008). Cluster analysis of elderly cardiac patients’ prehospital symptomatology. Nursing Research, 57, 14–23.

    Article  PubMed  Google Scholar 

  • McFarlane, A. C., & Papay, P. (1992). Multiple diagnoses in posttraumatic stress disorder in the victims of a natural disaster. Journal of Nervous and Mental Disorders, 180, 498–504.

    Article  CAS  Google Scholar 

  • Mollica, R. F., McInnes, K., Sarajlic, N., Lavelle, J., Sarajlic, I., & Massagli, M. P. (1999). Disability associated with psychiatric comorbidity and health status in Bosnian refugees living in Croatia. JAMA: The Journal of the American Medical Association, 282, 433–439.

    Article  CAS  Google Scholar 

  • Nicholson, A., Kuper, H., & Hemingway, H. (2006). Depression as an aetiologic and prognostic factor in coronary heart disease: A meta-analysis of 6362 events among 146 538 participants in 54 observational studies. European Heart Journal, 27, 2763–2774.

    Article  PubMed  Google Scholar 

  • Pedersen, S. S., & Denollet, J. (2004). Validity of the type D personality construct in Danish post-MI patients and healthy controls. Journal of Psychosom Research, 57, 265–272.

    Article  Google Scholar 

  • Pedersen, S. S., Middel, B., & Larsen, M. L. (2003). Posttraumatic stress disorder in first-time myocardial infarction patients. Heart and Lung, 32, 300–307.

    Article  PubMed  Google Scholar 

  • Riegel, B., Hanlon, A. L., McKinley, S., Moser, D. K., Meischke, H., Doering, L. V., et al. (2010). Differences in mortality in acute coronary syndrome symptom clusters. American Heart Journal, 159, 392–398.

    Article  PubMed  Google Scholar 

  • Roberge, M. A., Dupuis, G., & Marchand, A. (2010). Post-traumatic stress disorder following myocardial infarction: Prevalence and risk factors. Canadian Journal of Cardiology, 26, e170–e175.

    Article  PubMed  Google Scholar 

  • Rocha, L. P., Peterson, J. C., Meyers, B., Boutin-Foster, C., Charlson, M. E., Jayasinghe, N., et al. (2008). Incidence of posttraumatic stress disorder (PTSD) after myocardial infarction (MI) and predictors of ptsd symptoms post-MI—A brief report. International Journal of Psychiatry and Medicine, 38, 297–306.

    Article  Google Scholar 

  • Ruston, A., Clayton, J., & Calnan, M. (1998). Patients’ action during their cardiac event: Qualitative study exploring differences and modifiable factors. British Medical Journal, 316, 1060–1064.

    Article  PubMed  CAS  Google Scholar 

  • Ryan, C. J., DeVon, H. A., Horne, R., King, K. B., Milner, K., Moser, D. K., et al. (2007). Symptom clusters in acute myocardial infarction: A secondary data analysis. Nursing Research, 56, 72–81.

    Article  PubMed  Google Scholar 

  • Salcioglu, E., Basoglu, M., & Livanou, M. (2003). Long-term psychological outcome for non-treatment-seeking earthquake survivors in Turkey. Journal of Nervous and Mental Disorders, 191, 154–160.

    Google Scholar 

  • Shemesh, E., Rudnick, A., Kaluski, E., Milovanov, O., Salah, A., Alon, D., et al. (2001). A prospective study of posttraumatic stress symptoms and nonadherence in survivors of a myocardial infarction (MI). General Hospital Psychiatry, 23, 215–222.

    Article  PubMed  CAS  Google Scholar 

  • Shemesh, E., Yehuda, R., Milo, O., Dinur, I., Rudnick, A., Vered, Z., et al. (2004). Posttraumatic stress, nonadherence, and adverse outcome in survivors of a myocardial infarction. Psychosomatic Medicine, 66, 521–526.

    Article  PubMed  Google Scholar 

  • Spindler, H., & Pedersen, S. S. (2005). Posttraumatic stress disorder in the wake of heart disease: Prevalence, risk factors, and future research directions. Psychosomatic Medicine, 67, 715–723.

    Article  PubMed  Google Scholar 

  • Steptoe, A., Molloy, G. J., Messerli-Bürgy, N., Wikman, A., Randall, G., Perkins-Porras, L. & Kaski, J. C. (2011). Fear of dying and inflammation following acute coronary syndrome. European Heart Journal, 1–10.

  • Tabachnick, B. G., & Fidell, L. S. (1996). Using multivariate statistics. New York: HarperCollins.

    Google Scholar 

  • Tang, E. W., Wong, C. K., & Herbison, P. (2007). Global registry of acute coronary events (GRACE) hospital discharge risk score accurately predicts long-term mortality post acute coronary syndrome. American Heart Journal, 153, 29–35.

    Article  PubMed  Google Scholar 

  • Tedstone, J. E., & Tarrier, N. (2003). Posttraumatic stress disorder following medical illness and treatment. Clinical Psychology Review, 23, 409–448.

    Article  PubMed  Google Scholar 

  • Thombs, B. D., de Jonge, P., Coyne, J. C., Whooley, M. A., Frasure-Smith, N., Mitchell, A. J., et al. (2008). Depression screening and patient outcomes in cardiovascular care: A systematic review. JAMA: The Journal of the American Medical Association, 300, 2161–2171.

    Article  CAS  Google Scholar 

  • Thygesen, K., Alpert, J. S., & White, H. D. (2007). Universal definition of myocardial infarction. Journal of the American College of Cardiology, 50, 2173–2195.

    Article  PubMed  Google Scholar 

  • van Driel, R. C., & Op den Velde, W. (1995). Myocardial infarction and post-traumatic stress disorder. Journal of Traumatic Stress, 8, 151–159.

    Article  PubMed  Google Scholar 

  • Wardle, J., Robb, K., & Johnson, F. (2002). Assessing socioeconomic status in adolescents: The validity of a home affluence scale. Journal of Epidemiology and Community Health, 56, 595–599.

    Article  PubMed  CAS  Google Scholar 

  • Watson, D., & Pennebaker, J. W. (1989). Health complaints, stress and distress: Exploring the central role of Negative Affectivity. Psychological Review, 96, 234–254.

    Article  PubMed  CAS  Google Scholar 

  • Whitehead, D. L., Perkins-Porras, L., Strike, P. C., & Steptoe, A. (2006). Post-traumatic stress disorder in patients with cardiac disease: Predicting vulnerability from emotional responses during admission for acute coronary syndromes. Heart, 92, 1225–1229.

    Article  PubMed  CAS  Google Scholar 

  • Wiedemar, L., Schmid, J. P., Müller, J., Wittmann, L., Schnyder, U., Saner, H., et al. (2008). Prevalence and predictors of posttraumatic stress disorder in patients with acute myocardial infarction. Heart and Lung, 37, 113–121.

    Article  PubMed  Google Scholar 

  • Wikman, A., Bhattacharyya, M., Perkins-Porras, L., & Steptoe, A. (2008). Persistence of posttraumatic stress symptoms 12 and 36 months after acute coronary syndrome. Psychosomatic Medicine, 70, 764–772.

    Article  PubMed  Google Scholar 

  • Wikman, A., Molloy, G., Randall, G. & Steptoe, A. (2011). Cognitive predictors of posttraumatic stress symptoms. Psychology & Health, 1–15.

  • Zerwic, J. J. (1998). Symptoms of acute myocardial infarction: expectations of a community sample. Heart and Lung, 27, 75–81.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

This study was supported by the British Heart Foundation (RG/05/006) and the Medical Research Council. NMB was supported by the Swiss National Foundation (PBBE1-117004). The funding sources have not been involved in the submission of the manuscript or in the decision to publish the data.

Author information

Authors and Affiliations

  1. Department of Epidemiology and Public Health, University College London, London, UK

    Anna Wikman, Gemma Randall & Andrew Steptoe

  2. Department of Molecular Medicine and Surgery, Upper Gastrointestinal Research, Karolinska Institutet, Norra Stationsgatan 67, level 2, 171 76, Stockholm, Sweden

    Anna Wikman

  3. Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland

    Nadine Messerli-Bürgy

  4. Department of Psychology, University of Stirling, Stirling, Scotland, UK

    Gerard J. Molloy

  5. Community Health Sciences, St Georges, University of London, London, UK

    Linda Perkins-Porras

Authors
  1. Anna Wikman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nadine Messerli-Bürgy
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gerard J. Molloy
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gemma Randall
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Linda Perkins-Porras
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Andrew Steptoe
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anna Wikman.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wikman, A., Messerli-Bürgy, N., Molloy, G.J. et al. Symptom experience during acute coronary syndrome and the development of posttraumatic stress symptoms. J Behav Med 35, 420–430 (2012). https://doi.org/10.1007/s10865-011-9369-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10865-011-9369-x

Keywords

Search

Navigation