A substantial number of patients in the initial stages of a heart attack or severe chest pain crisis - events lumped together as “acute coronary syndrome” or ACS - experience extreme stress and fear of dying. This can lead to long-lasting depression and anxiety, according to a new study.

“Experiencing an ACS may provoke a range of negative emotional responses, including acute distress and fear of dying,” Dr. Andrew Steptoe and colleagues from University College London, UK, write. “The frequency of these emotional states has rarely been assessed.”

To investigate, the researchers studied 184 patients with ACS, along with the correlates and consequences of their emotional states.

Forty patients (22 percent) reported intense distress and fear of dying, Steptoe’s group reports in the American Journal of Cardiology. Ninety-five (52 percent) patients reported moderate distress and fear.

Intense distress and fear was associated with female gender, lower levels of education, greater chest pain, and emotional upset in the two hours before ACS onset.

Patients who exercised regularly were less likely to have acute distress or fear. Having no distress or fear was also more common in patients who did not at first attribute their chest pain to cardiac causes.

Acute distress and fear of dying predicted greater depression and anxiety levels a week after the ACS, and high levels of depression three months later.

The factors that trigger depression after a heart attack “differ in several respects from those for depression in general,” Steptoe’s team notes. “Greater understanding may accrue from more precise delineation of the trajectory of emotional responses, including factors preceding symptom onset, acute fear and distress during the early symptomatic phase, and later development of depression and anxiety.”

SOURCE: American Journal of Cardiology, December 2005.