Stress and Heart Disease
By Qutaybeh Maghaydah, MD, FACC
If you find yourself feeling
stressed out much of the time, you should seriously consider making changes in
your life. Research conducted over the past 35 years has demonstrated that
acute and chronic stress may be as detrimental to the health of your heart as
high blood pressure and high cholesterol. Learning to reduce stress in your
life when you can and to manage stress effectively when it does occur could
help you live longer.
What do the case studies tell us
about acute stress?
Case studies have revealed a number
of significant findings. Early studies describe cardiac arrest or sudden death
in response to acute stress, such as grief or fear. Sudden emotional stress,
such as learning of the death of a close relative, can precipitate severe but
reversible left ventricular dysfunction even in the hearts of people without
existing cardiac disease.
One study showed proarrhythmia
(provoked undesirable heart rhythm) changes in the EKGs of healthy house
officers exposed to the sudden stress of an on-call alarm. Another interesting
study revealed an increase in ventricular arrhythmia among New York City
residents with implanted cardioverter defibrillators (ICDs) in the weeks
immediately following 9/11. This population of patients experienced a higher
rate of ICD shocks to restore normal heart rhythm after the terrorist attacks
significantly increased the level of stress in their lives.
In patients diagnosed with coronary
artery disease (CAD), acute stress can be a potent trigger of myocardial
ischemia, which occurs when the heart is receiving an inadequate supply of
blood and oxygen.
What about the affects of chronic
People react internally to the
environmental triggers associated with long-term situations, such as an unhappy
or abusive marriage or unresolved job stress. Our responses to these stressful
triggers affect our emotions, behavior, ability to perceive and understand, and
our psychological wellbeing. The result can be anger and hostility, depression
and anxiety, or the lack of a network of social support, all of which are all
associated with an increased risk for heart disease.
Are there specific, proven links
between our emotions in reaction to stress and the development of coronary
Yes, there are a number of direct
pathophysiologic mechanisms by which our emotions may affect the heart.
Dysfunction of the autonomic nervous system in general, and of the
hypothalamus, pituitary, and adrenal glands specifically, link emotion and
coronary artery disease. While there are
too many to mention in a brief article, some of the affects include: An
increase in adrenalin that raises the heart rate and blood pressure and
constricts the arteries, which can hinder heart muscle function; impairment of
blood platelet functioning, which causes blood to clot more quickly and can
lead to heart attack; and impaired functioning of the vagus nerve, which helps
to control heart rate.
What steps can I take to manage
stress more effectively?
There are a number of strategies
that can help you manage stress. Learning relaxation techniques, doing
breathing exercises, and practicing yoga can be very helpful in stress
reduction, in part because they lower heart rate and blood pressure. If you lack
a network of social support in your life, it may be helpful to join a support
group. Regular exercise provides all kinds of healthful benefits, one being
Lifestyle change can be difficult
and you may want some help in making changes in your life. The Center for
Healthy Living at Island Health Center teaches stress management. Or you might
find couples counseling, anger management training, or psychotherapy helpful.
The prevailing attitude about
stress has been that it is an unpleasant fact of life. However, now we know
that it can also be injurious not only to our happiness but to our health. If
you feel stressed out much of the time, talk to your doctor about how to
initiate healthful changes in your life. It could help you prevent or postpone
the onset of heart disease.
Maghaydah is a board-certified cardiologist and a fellow of the American
College of Cardiology on the medical staff of Cayuga Medical Center. He is in
practice with Dr. Jonathan Mauser at Cayuga Cardiology, where he can be reached
at (607) 269-0100.