Research Summaries
Why was the study done?
Research focused on the cardiac cycle of patients with posttraumatic stress disorder (PTSD) and on cardiac function in stressful occupations is limited. The current study was designed to present a review of the existing literature on PTSD and cardiac function to provide insight into the importance of cardiac monitoring, which could potentially be applied to the types of stressful occupational settings experienced by first responders and other public safety personnel (PSP). The current study also provided a “proof-of-concept” case study on the use of seismocardiography (SCG), a noninvasive measurement of heartbeat vibration within the chest, to monitor cardiac function following a series of acute occupational stressors.
What was done in the study?
Researchers conducted a literature review of articles examining echocardiography and PTSD or related symptoms from PubMed, MEDLINE, and Web of Science databases. Assessing cardiac function in a clinical setting is usually done using echocardiography, the “gold standard” diagnostic technique, which uses ultrasound imaging of the heart. A total of 87 studies were retrieved, and after screening for duplication and for relevance, 14 articles were included in the current study.
Data from a case study of one participant were included in the current study to illustrate the effects of potentially psychologically traumatic events (PPTE) on cardiac function. Daily cardiac data were collected for one month using a noninvasive seismocardiographic sensor from a 33 year old male participant working in a high pressure hospital setting, and included three incidents of prominent occupational stress. SCG is a reliable and noninvasive cardiac diagnostic that requires less costly equipment, and less time and technical expertise to operate than echocardiography.
What did we find out?
Very few existing studies on mental health use echocardiography. Very few existing studies focus on assessing cardiac changes associated with PTSD or changes caused by stressful occupations. Among the few such studies available, there is lots variation with respect to measurement tools and study design, and lots of variation with respect to results.
Cardiac dysfunction, as measured by the myocardial performance index (MPI), varied across the available studies; however, there does appear to be evidence that patience with PTSD have cardiac impairments related to diastolic (pressure in the arteries between heartbeats, or the relaxation phase of the heart) and systolic (pressure in the arteries during heartbeat, or the contraction phase of the heart) measurements.
The echocardiography research with PTSD suggests that impaired left ventricular diastolic function, a condition impacting overall heart function, is associated with PTSD in the absence of other cardiac complications. Most of the available studies involved data from patients with pre-existing complications.
The literature review results also identified a reversible condition called Takotsubo cardiomyopathy, which features myocardial infarction- (or ‘heart attack-‘) like symptoms brought on by extreme stress.
The case study data indicated that occupational stress elevated cardiac performance indices, suggesting increased ventricular stress, which is consistent with results from previous studies. Prolonged exposure to ventricular stress can cause adverse effects on the heart, potentially leading to heart failure. The current case study also serves as a “proof-of-concept” that impairments in cardiac cycle timing intervals may occur during acute occupational stressors, which is a novel research finding.
Where do we go from here?
The current case study results suggest that the potential diastolic dysfunction present in PTSD can result from elevated stress accumulated during acute periods of stress, which can explain altered cardiac function in PTSD following repeated stressors. The results of the current literature review and case study suggest noninvasive cardiac monitoring via seismocardiography can be used to help identify the changes induced by PPTE exposures. PPTE exposures and other cumulative stressors can lead to chronic mental health challenges, including PTSD and other posttraumatic stress injuries (PTSI); therefore, early detection of cardiac dysfunction can serve as a proactive tool for protecting mental health.
The current study results help to continue advancing Canada’s first-ever National Action Plan on Post-Traumatic Stress Injuries, including additional investment to support the health and well-being of first responders and other public safety personnel.
The original wording of the study was changed and condensed for the current research summary.
The RCMP Study is funded by support from the RCMP, the Government of Canada, and the Ministry of Public Safety and Emergency Preparedness. The development, analyses, and distribution of the current article was made possible by a generous and much-appreciated grant from the Medavie Foundation.
Original study
Singh, J., Carleton, R.N., Neary, J.P. Cardiac function and posttraumatic stress disorder: A review of the literature and case report. Health Promot Chronic Dis Prev Can. 2023;43(10/11):472-80. https://doi.org/10.24095/hpcdp.43.10/11.05
Prepared by K. Vincent
