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).
J Cardiopulm Rehabil Prev. 2019 Sep;39(5):E20-E23. doi: 10.1097/HCR.0000000000000460.
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.
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.
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.
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.
有研究报道，经历自发性冠状动脉夹层（SCAD）的患者中抑郁和焦虑的发生率较高，但创伤后应激障碍（PTSD）的发生率尚不清楚。本研究旨在调查经历 SCAD 的女性中 PTSD 症状的发生情况。
这是一项横断面的初步研究，共纳入 14 名经历 SCAD 的女性患者，平均年龄为 51 岁，在 SCAD 后中位数为 35 个月时，对其进行了标准化的心理社会问卷调查。这些患者由心脏病专家确定为发生过 SCAD 事件，同时被邀请参加 SCAD 幸存者的心理社会小组。
参与者报告了当前的应激症状（93%）、失眠（57%）、焦虑（71%）、抑郁（36%）和 PTSD（43%）。在报告有精神病史的 11 名女性中，有 8 名（72.7%）表示她们的症状与经历过 SCAD 有关。健康相关的生活质量和社会支持与其他所有女性的心脏样本相当。感知控制模式与癌症患者更相似，而与其他心脏患者不同，SCAD 患者认为“机会”比“自我控制”更有可能影响医疗结果。
在对 SCAD 患者进行的首次创伤后应激评估中，PTSD 症状的发生率令人担忧。SCAD 的意外性质和缺乏已知的治疗选择可能是导致患者痛苦的原因。未来需要进一步研究来准确估计 SCAD 后的 PTSD 发生率，并评估治疗的效果。
