Pulmonary embolism – a psychological killer?

Talk Summary by Barbara Walkowiak

Many of us are afraid of cardiovascular disease, and very much aware that if a blood clot forms in the vessels in our brain or heart, it can be life-threatening. What we do not usually think about is what happens when such a clot appears in the blood vessels supporting our lungs — a condition that is known as pulmonary embolism. In her talk for the 2020 VarsitySci symposium, Anna Tran convinced us we should care not only about the condition itself, but also about its impact on patients’ mental health.

“Many patients are so afraid of reliving the experience that they start to live in a constant state of alarm, being hyper-aware of potential signs of an upcoming attack.”

Pulmonary embolism (PE) is neither very common, nor does it have a high mortality rate. Nevertheless, it can leave the lung tissue permanently damaged, especially if a correct diagnosis is not promptly made. Not only that, but the symptoms of this condition may leave patients very distressed: imagine going on a walk and suddenly feeling out of breath, experiencing sharp chest pain and increased heart rate, for no obvious reason. Many patients are so afraid of reliving the experience that they start to live in a constant state of alarm, being hyper-aware of potential signs of an upcoming attack. The condition even has a name —post-thrombotic panic syndrome (PTPS).

Added to this, patients often experience intrusive thoughts and memories, persisting up to 20 years after the event. Such symptoms led to the question of whether the condition is essentially post-traumatic stress disorder, PTSD, characterized by recurring memories of the traumatic event from the past.

To test whether the problem is there, but  neglected by both doctors and patients, the team consisting of Anna Tran, Dr Kerstin de Weit and Dr Marcus Redley conducted a retrospective study on a group of patients from Canada. In the first part, 75 PE patients filled in a questionnaire about their mental health symptoms based on the official diagnostic criteria for PTSD. Then, the researchers interviewed 37 of them about their mental health after their PE event.

Both parts of the study revealed the psychological distress that may be associated with PE. Although only 3% of PE patients were diagnosed with concurrent PTSD, as much as 57% of them experienced some negative impact on their mental health. The anxiety stemmed mainly from fear of the event’s possible recurrence, as patients were highly distressed by the experience and were deeply afraid of reliving it for a second time. These feelings often led patients to be very dependent on the blood-thinning drugs they took in order to prevent clot formation.  Although being diligent with pill taking is generally a good thing, patients often carried on doing it when it was no longer necessary. Some even did it despite being injured, which meant that their blood could not clot to prevent the bleeding.

Despite this evidence, it wasn’t all grim. For some, the experience had a positive side, as it made patients more grateful for receiving medical treatment and made them realize the value of available healthcare.

The study also pinpointed the crucial role health professionals play in shaping patients’ mental health. Delivering the diagnosis and ensuring patients will comply with their medications is not easy, as many clinicians would attest. However, the study revealed that how they communicated the diagnosis had a major impact on the patients’ subsequent mental health symptoms. When a patient was told they were ‘a ticking bomb’ or ‘almost died yesterday’, they were more likely to experience subsequent anxiety and fear. On the other hand, delivering the diagnosis more calmly did not have such debilitating effects.

Where does this lead us? Firstly, we cannot ignore the mental health implications of experiencing traumatic physical health events any longer. Patients should have more options to discuss their feelings, and not be afraid of telling their doctors about anxiety, fear or recurring memories that can have a direct negative impact on their life quality. At the same time, doctors should remember that how they deliver the diagnosis may have a tremendous effect on how the patient ends up feeling. While it may be challenging to get the communication right each time, avoiding threatening statements is bound to help a lot.

This article gives a report of the talk hosted by Anna Tran on the 23rd of September- Day 3 at the Oxbridge Varsity Sci Symposium.