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Patient-Reported Psychological Distress After Spontaneous Coronary Artery Dissection


Edwards, Katharine S. PhD; Vaca, Kelsey C. MS; Naderi, Sahar MD, MHS; Tremmel, Jennifer A. MD, SM

Journal of Cardiopulmonary Rehabilitation and Prevention: September 2019 - Volume 39 - Issue 5 - p E20–E23
doi: 10.1097/HCR.0000000000000460
Brief Reports

Purpose: High rates of depression and anxiety are reported among patients who have experienced spontaneous coronary artery dissection (SCAD) but the incidence of post-traumatic stress disorder (PTSD) is unknown. The purpose of this study was to investigate symptoms of PTSD in women who have experienced SCAD.

Methods: This cross-sectional pilot study included 14 female SCAD patients, mean age of 51 yr, who responded to standardized psychosocial questionnaires at a median of 35 mo post-SCAD. Patients were identified by cardiologists as having had a SCAD event and were concurrently invited to participate in a psychosocial group for SCAD survivors.

Results: Participants reported current symptoms of stress (93%), insomnia (57%), anxiety (71%), depression (36%), and PTSD (43%). Eight of the 11 women who reported having a mental health history (72.7%) indicated that their symptoms were related to having experienced SCAD. Health-related quality of life and social support were comparable with other all-female cardiac samples. Patterns of perceived control were more similar to those of patients with cancer than other cardiac patients in that SCAD patients ranked “chance” as more likely than “self-control” to impact medical outcomes.

Conclusions: The prevalence of PTSD symptoms in this first-known assessment of post-traumatic stress among SCAD patients is concerning. The unexpected nature of SCAD and lack of known treatment options may play a role in patient distress. Future research is needed to accurately estimate rates of PTSD after SCAD and assess the benefits of treatment.

Emotional distress is common among patients with spontaneous coronary artery dissection (SCAD) but the rate of post-traumatic stress disorder (PTSD) is unknown. Forty-three percent of patients in a female sample (n = 14, mean age: 51 yr) reported clinically significant symptoms of post-traumatic stress on a self-report questionnaire (Impact of Events Scale—Revised) at median 35 mo post-SCAD.

Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California (Drs Edwards and Tremmel); PGSP-Stanford PsyD Consortium, Palo Alto University, Palo Alto, California (Ms Vaca); and Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, California (Dr Naderi).

Correspondence: Katharine S. Edwards, PhD, Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Dr, Rm H2103, Stanford, CA 94305 (

The authors declare no conflicts of interest.

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