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The emotional toll of a heart attack can be so severe that an estimated 1 in 8 patients who survive the experience develop post-traumatic stress disorder , a condition that doubles the risk of dying of a second heart attack, according to new research.

While it has long been known that a heart attack affects both physical and mental health, most doctors and patients are not aware that the emotional stress of a life-threatening heart event can develop into full-blown post-traumatic stress disorder, or P.T.S.D. The disorder, which more typically affects combat veterans and victims of violent crime, can be particularly insidious in heart patients, who live with constant trepidation about their own bodies, frequently paying anxious attention to each heartbeat or twinge of chest discomfort.

While several small studies have suggested P.T.S.D. is an issue for heart patients, most have been too small to reach any meaningful conclusions. In the new report, researchers from Columbia University Medical Center combined the results of 24 studies that had documented post-traumatic stress in a total of 2,383 heart patients. Their analysis, published online in the journal PLoS One, found not only that P.T.S.D. after a heart attack was far more common than previously believed, but also that the disorder doubled the risk of dying of a second event over the next one to three years, compared with those who did not have P.T.S.D.

Symptoms of the disorder include frequent intrusive thoughts about the stressful event, nightmares and sleep problems and anxiety, among others. An estimated 1.4 million patients are discharged from hospitals in the United States each year after a heart attack or other acute coronary event. The results of the Columbia study suggest that about 168,000 of them will develop clinically significant symptoms of P.T.S.D.

“I think that the broader cardiology community and medical community haven’t really paid attention to this issue,” said Donald Edmondson, assistant professor of behavioral medicine at Columbia and the study’s lead author. “When you think of P.T.S.D. due to combat or a traumatic event, the patient experiences intrusive memories reliving an external event. But this type of trauma is something that is internal.”

For Gary Dorman, 64, of Hillsdale, N.Y., the stress of living with a weakened heart has been ever-present since his heart attack 12 years ago. Although he was active and seemingly in good physical health, he woke up one morning with chest pain that he thought was caused by indigestion. When he began sweating profusely, he recalled a conversation years earlier about sweating being a symptom of heart attack. His wife quickly called paramedics, but he was first taken to a community hospital before being transferred to a larger hospital better equipped to deal with heart problems. The delay left him with a severely damaged heart, and soon he ended up on full disability, unable to work.

Today, he lives with constant reminders of his heart trouble, whether that means staying inside on hot days or becoming dizzy if he stands up quickly. “It has become my whole life,” Mr. Dorman said. “It starts in the morning, taking my breakfast of about 12 different medications.”

Mr. Dorman, who suffered depression after his heart attack and has trouble sleeping, was only recently given a diagnosis of P.T.S.D. An antidepressant has helped, and he does his best to stay active, fishing, gardening, hiking and walking.

In the Columbia study, the severity of the heart event was not a factor in a patient’s risk of developing P.T.S.D. Instead, the research found that patients who were relatively young when they experienced their first heart event, and those who subjectively felt that their lives were in danger and that they had lost control, were at greatest risk for the disorder.

One theory about why P.T.S.D. may increase mortality risk is that heart patients may avoid taking medications so as not to be reminded of their condition.

Post-traumatic stress disorder is typically treated with behavioral therapy and antidepressants. Dr. Edmondson said he hopes that future research will focus on ways to minimize the trauma for patients at the time of the heart attack to prevent patients from developing P.T.S.D. symptoms later.

“We know where the vast majority of these traumas are going to take place, and that’s in emergency departments where heart patients show up,” Dr. Edmondson said. “We are interested now in trying to determine whether there are ways to alter that environment to decrease perceptions of life threat and lack of control so we can reduce the incidence of P.T.S.D. in the first place.”