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‘Sadly, I Did Survive’: The Psychological and Neurological Effects of SCA
Shannon and her husband had just been seated at the restaurant to celebrate a very special Valentine’s Day. All dressed up and ready for a nice evening out, she glanced at the menu and started to feel warm. Suddenly she was having trouble breathing.
She asked to move to another part of the restaurant, away from the heat piping. The feelings didn’t go away—they intensified. Shannon felt her heart, her mind and her thoughts all racing. Every sound in the restaurant was amplified—the chairs, the chatter, everything. Unable to bear it, she jumped up and dashed out of the restaurant, then collapsed in her husband’s arms.
She didn’t die—that had happened a few weeks earlier.
In December Shannon was baking Christmas cookies when she felt an intense pressure in her chest, like bad heartburn, as well as shortness of breath. She immediately called 9-1-1, and an ambulance took her to the hospital. There she was diagnosed with heartburn, given antinausea medication and a sedative, and sent home. She spent the next day still in pain, popping Tums and going in and out of consciousness. Finally, after two days, her husband drove her to a clinic, where doctors discovered she was tachycardic. She was again rushed to the hospital, where this time they discovered a 100% blockage of her left anterior descending artery (the famed “widow-maker” heart attack). She underwent successful angioplasty and stent placement and was discharged a few days later.
Then on the evening of December 15, Shannon went into cardiac arrest at home. Thankfully her visiting uncle noticed she’d turned blue and wasn’t breathing. He started CPR, and her aunt called 9-1-1. Shannon was defibrillated twice, received CPR and was put into a 24-hour coma. Surgeons implanted a cardioverter defibrillator, and Shannon was discharged again on Christmas Eve.
Valentine’s day. The heat. The shortness of breath. Overwhelming the senses. Outside the restaurant Shannon collapsed into an anxiety attack the likes of which she’d never known. She was embarrassed and felt foolish but knew she wanted to get home to her safe place.
Meet Shannon, sudden cardiac arrest survivor, and now anxiety sufferer. The first led to the second, and it’s not uncommon. Survivors of OHCA report high rates of mental distress, with up to 61% experiencing anxiety, 45% experiencing depression and 27% experiencing post-traumatic stress. Fatigue seems a commonly reported long-term outcome for OHCA survivors.
For Shannon this manifested as a fear of being home alone and a horrible fear of falling asleep. “The feeling of fatigue reminded me of the feeling I’d had just prior to my cardiac arrest,” she says. “So every time I felt tired, I thought I was going to die, and therefore I would not allow myself to fall asleep. If I did happen to fall asleep, I would jolt myself awake and panic. I’ve overcome this fear by saying a little prayer before I fall asleep and when I wake up in the morning, and now I’m sleeping better than I was prior to these events.”
Shannon has also met with a local psychologist and is hopefully on the way to recovery, learning to manage the episodes and reduce them with time.
An old term (now out of favor) used to describe patients who had a cardiac event and then returned regularly to the ER for every odd twinge between the belly button and trachea was cardiac cripple. The data supports that there can be definitive neurological and psychological damage to the survivors of SCA, even those who appear healthiest—no vents, no pumps, discharged home. Anxiety attacks, along with depression and perhaps PTSD, top survivor complaints about their health.
A study of 188 SCA survivors from the Sudden Cardiac Arrest Association patient registry revealed that clinically relevant cardiac anxiety and cardioprotective behaviors were frequent, and 18% of survivors reported persistent worry about their hearts even when presented with normal test results. SCA survivors exhibit high levels of cardiac-specific fear, avoidance and preoccupation with cardiac symptoms. Successful management of SCA patients requires attention to postevent anxiety about cardiac functioning and security.
Some survivors go so far as to express regret at not dying. Many speak about a lack of self-worth and feeling like a burden to their families.
One in-hospital arrest survivor called for help, then experienced cardiopulmonary arrest as a nurse began to suction out secretions. “I was resuscitated and spent three weeks in a coma, which I was not expected to survive,” she says. “Sadly, I did survive. When I began rehabilitation I realized something was very wrong. My balance was gone, and I lost visual focus when I moved my head. This symptom (oscillopsia) has continued ever since. It never abates unless I’m perfectly still, and it’s quite disruptive and disabling. I’ve sought treatment for years to no avail. I find this new type of existence excruciating, exhausting and devoid of prospects. Every day I wake to this nightmare. Every day I cry. Sometimes it’s better just to stay dead.”
Sequelae like this aren’t uncommon either. One published article says that between 30%–50% of OHCA survivors experience cognitive deficits for up to several years postdischarge. Deficits of attention, declarative memory, executive function, visuospatial abilities and verbal fluency are commonly reported. These patients may have received underdiagnosis of mild traumatic brain injury and not been properly referred for specialist care. But as a result their “rebirthdays” and lives are often filled with fear, stress and depression.
While data on cardiac arrest survivors is sparse, the data gets smaller with the size of the patient. There are almost no long-term psychological or neurological studies of pediatric patients who have survived cardiac arrest. Do they experience the same anxieties? Do they refrain from activities? Do their parents/guardians discourage them from activity? We don’t know.
Among the small cadre of experts in the psychological care of SCA survivors is the Sudden Cardiac Arrest Association. The SCAA’s COPE-LINE (855/COPE-SCA) puts survivors in touch with survivors to talk about their experiences. This ingenious program began in July 2016. Survivors and patients with implanted cardioverter-defibrillators can call the line and receive a call back from a “designated survivor.”
Rob Curran has been an EMT in New York City for over 15 years. He instructs undergraduate and graduate pathophysiology at SUNY-Downstate and human anatomy and physiology at CUNY-Brooklyn College.
Comments
I had cardiac arrest on August 20, 2021 followed by 3 months in hospitals during pandemic. Arrest exacerbated panic attacks to ptsd. I am medication resistant to antidepressants and anttianxiety medication.
—Nancy Purdue