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Emotional Health and Stress Can Affect Heart Health

Risk factors for heart disease are usually discussed in terms of things we can and cannot change. Age and heredity (family genetics) are among items that we cannot change. As challenging as they may seem, what we eat, how active we are (or are not) and quitting tobacco are considered key factors we can modify or change. Other risk factors can include chronic diseases like diabetes or COPD, our emotional health and how we handle stress.

February is National Heart Health month. One set of risk factors that is often overlooked is our emotional health and how we handle stress. Both can affect our heart health.

One way our emotional health can affect our heart health is through a diagnosis called stress cardiomyopathy, also known as "broken heart syndrome". Researchers at Johns Hopkins University, including Ilan Wittstein, MD, a cardiologist, shared that they noticed people with the condition were either grieving the loss of a loved one, or had experienced a traumatic event like a car accident or were a crime victim. Per Peter Shapiro, MD, a professor of clinical psychiatry at Columbia University, the nervous system is triggered by the event, activating your "fight or flight" reaction, which floods your body with chemicals, including adrenaline, a stress hormone. This release can stun your heart muscle, leaving it unable to pump properly. If the heart cannot pump blood to the body, strongly enough, the person may develop heart failure, which according to Wittstien, can be life-threatening. The National Institute of Health states that the failure is severe, but often short-term.

The symptoms of "broken heart syndrome" can be similar to a heart attack: chest pain, shortness of breath, arm pain and sweating. Even though stress cardiomyopathy is different than a heart attack, DO NOT QUESTION which one you may be having if you have signs and symptoms. Call 911 or go to the Emergency Department and let the doctors figure out which one it may be. More than 90% of people with broken heart syndrome are women, and it is common after menopause. Wittstein encourages people to discuss grief, stress and trauma with their health care provider, to include any physical stressor like an asthma attack or low blood sugar, as all can be triggers.

A health care provider may request an angiogram, which provides images of the heart's blood vessels. During a heart attack, one or more arteries may be blocked, but during broken heart syndrome, all are clear. An echocardiogram, "echo", may be performed to show the shape of the heart and can determine if the ventricles of the heart are enlarged, which indicates cardiomyopathy. According to the National Institute of Health, the symptoms of broken heart syndrome are treatable, and most people who experience it have a full recovery, usually within days or weeks. The heart muscle is not permanently damaged, and the risk of broken heart syndrome happening again is low.

Another way our emotional health and how we deal with stress can affect our heart health is by exposure to chronic, everyday stressors. This can be similar to the above, but instead of a severe event, with a short term stress exposure, our 'fight or flight' response is triggered at a lower, but constant level, releasing chemicals, including the stress hormone adrenaline, into our body for days or weeks, without rest.

The link between emotional health, chronic stress and heart disease is not clear and more research is needed. Depression is reported in an estimated 1 in 10 of Americans ages 18 and older, and the figure can be as high as 33 percent for heart attack patients. Unhealthy lifestyle behaviors can also be used to deal with symptoms of depression and anxiety, affecting our heart health. "When people are stressed, anxious or feeling down, they're not apt to make the healthy choice because they're so overwhelmed by their situation," says Nieca Goldberg, M.D., medical director of the Joan H. Tisch Center for Women's Health at NYU Langone Medical Center in New York. "A person's mental health, in terms of their general health, is underestimated." It's not surprising if you find it hard to get plenty of exercise, eat heart-healthy foods, limit alcohol or kick a smoking habit. All those things can seem like "just one more thing to add to their list of things that is already causing stress," Dr. Goldberg said. "People turn to things that give them comfort and aren't thinking about whether those things are healthy or not." Eating high fat foods and lack of activity can lead to being overweight. Being overweight, eating foods with high sodium content, lack of activity and drinking too much alcohol are contributing factors to high blood pressure. Emotions and stress can drive unhealthy lifestyle choices, which can directly and indirectly cause heart disease.

The National Institute of Health emphasizes that regular physical activity not only relieves stress and depression but also can directly lower the risk of heart disease. Stress management programs, as well as support groups for heart patients, can also help develop new ways of handling everyday life challenges. Much remains to be learned about the connections among stress, depression, and heart disease, but a few things are clear: staying physically active, developing a wide circle of supportive people in your life, and sharing your feelings and concerns with them can help you to be happier and live longer.

As with any chronic disease or health concern, please discuss with your health care provider.

Article provided by Dana Breeding, RN Health Educator with Community Outreach.