Acute myocardial infarction and posttraumatic stress disorder: the consequences of cumulative adversity

This article examines the experiences of acute myocardial infarction (AMI) patients who are at high risk for reinfarction or sudden death to determine the impact of posttraumatic stress disorder (PTSD), accumulated burden of adversity, and trauma spectrum disorder on subsequent AMI care-seeking. Individuals experiencing an AMI have been studied with regard to depression and anxiety disorders, but negligible attention has been given to the PTSD potential of the total cardiovascular disease experience. Yet, growing evidence suggests the traumatogenic potential of AMI, with its sudden and unexpected onset, dramatic changes in life circumstance, and the additive effect of comorbid life events, is significant in producing impaired and extended coping during subsequent ischemic events. Consideration of PTSD and a continuum of cumulative adversity provides a more complex and fully drawn understanding of the circumstances surrounding AMI coping and reasons for delayed access to thrombolysis.