Finding Peace after Terror

Anxiety, anger and hostility are very commonly seen features in our population. The recent heartless massacre in Pahalgam has again been a trigger for these negatives coming in the lives of a large number of people who were affected, whether from Kashmir valley or from the other parts of the country. Young men from Kashmir to Kanyakumari and from Assam to Maharashtra were involved. Things have become so precipitous that nothing short of teaching a lesson, by kinetic intrusion of the perpetrators’ land, is acceptable to most. They are not realizing that a war means more casualties of young men, both Jawans and officers, leading to more anguish and hostility. People are not satisfied with diplomatic moves like putting in abeyance the Indus water treaty, imposing travel restrictions etc. They just want “badla” (revenge) at any cost, to satisfy their feelings which are badly hurt. Is that sanity?

This anger is part of the human nature. Links between the heart and emotion have been postulated for centuries. However, data supporting this connection have only become available recently. A growing body of evidence now suggests that negative affective states, including anxiety, lead to an increased risk for cardiovascular disease, and that the presence of negative affective states are associated with poor long-term prognosis. People who already have risk factors for heart disease like high blood pressure, diabetes or a previous history of a heart attack are more vulnerable. Several studies have found that anxiety is associated with increased cardiac mortality in patients with heart disease. This fact, however, is contested by some researchers.

Severe anxiety can often mimic symptoms of a heart attack. It can result in breathlessness, palpitation, sweating and an impending death. Such situations need to be resolved quickly by consulting a doctor, getting an electrocardiography done and at times some more tests like biomarker estimation, the commonest being the troponin test. These episodes are often labelled as panic attacks. While panic attacks themselves are not deadly, there is accumulating evidence that patients with panic disorder are more prone to get serious problems like sudden death if they actually get a heart attack. It is therefore important to recognize panic disorder in the absence of heart disease both for heart health and psychological well-being. The mechanism of the panic attack is often hyperventilation, a surge of adrenaline release or hypersensitivity.

The treatment of panic disorder without a known cause in persons without heart disease is cognitive- behavioral therapy and specific drug therapy using a group of medicines called serotonin reuptake inhibitors. These individuals should also be advised regarding the importance of minimizing the use of caffeine, alcohol and stimulant drugs. Maintaining a good sleep hygiene is important adjunct.

Hostility and Heart Disease

Hostility is a personality trait that includes being resentful, impatient or irritable. At times such individuals are unnecessarily sarcastic or cynical. It’s not just a one-off occurrence but characterizes how a person interacts with people. This trait is often seen in patients who have had a heart attack and is often seen in smokers, inactive persons with poor health behaviors. It has been established that taking control of lifestyle habits improves the outlook and good counselling is very effective. Family members and colleagues are usually the first to notice these personality changes. These should be taken seriously and conveyed to the closest family member. An early action through counselling by an expert is necessary to help the sufferer.

Normal Anxiety and Heart Disease

Following a major heart event, such as a myocardial infarction (heart attack), or after angioplasty or bypass surgery anxiety is the norm. Patients are suddenly confronted with their own life in danger and are understandably concerned about the potential future impact on their lives. It is important for the treating physician to anticipate this “normal illness-related anxiety” and address it promptly to prevent avoidable complications.

Serious cardiac events are traumatic and life-threatening. Some patients develop intrusive thoughts, memories, or nightmares about their cardiac event; avoidance of situations that remind them of the event is important. Such individuals have increased irritability and lack of sleep. When these symptoms have been present for a short time after the traumatic event, they are considered as acute stress disorders but if they persist for more than a few months, they are classified as post-traumatic stress disorders by psychiatrists. These require specific medications under supervision. Self-medications by drugs like alprazolam and sleeping tablets etc., should be avoided. These can interfere with the specific medications often prescribed by the treating physician or psychiatrist.

Take Home Message

There is growing evidence that anxiety is an independent risk factor for the development of heart disease. Anxiety following a heart attack or related illness can slow down the recovery process and can be associated with higher morbidity and mortality.

The trait of being hostile is often seen after getting a major illness like a heart attack. Unless managed well it can lead to another episode. Treating such disorders is important. The management consists of psycho education, behavioral therapy and in many cases medications from the group of serotonin reuptake inhibitors taken under medical supervision. An early recognition and management are the keys.

Prof Upendra Kaul, Founder Director,

Gauri Kaul Foundation.