JOIN USDivya* was confident that her husband Kumar’s* chest pain was not a heart attack. After all, he was only 35 years old and had never smoked a single cigarette. All his “routine” medical check-ups were always normal — no diabetes, hypertension or cholesterol. Both his parents were healthy and well into their 70s. So it was hard for her to believe when the cardiologist said that Kumar was having a massive heart attack and had to be admitted to the critical care unit.
However, for the cardiologists and nurses at the unit, this was a common case. Kumar had been pushing himself to the limits for his promotion — skipping meals, no exercise, no entertainment, working 48 hours with no sleep, and had gone into extreme depression after he suddenly lost his job.
Kumar, like hundreds of other youngsters, is a victim of stress. Stress is simply a state of mental tension caused as a result of adverse or demanding circumstances. While it is a fact that stress increases depression, anxiety and frustration, it has now become a known cause for heart-related disorders.
Does stress really affect the heart?
It has only recently been proven that chronic emotional stress is one of the risk factors for heart attacks. Other less-proven associations are acute stress, personality traits (Type A), and anger. Large-scale disasters like earthquakes often lead to several cases of heart attacks immediately after the event.
How does stress affect the heart?
Stress response has been around for millions of years. Stress response prepares us to deal with adverse situations — the “fight or flight” response. For example, stressful situation for prehistoric man was encountering a predator, which required him to either fight or escape. At such times, the hormone adrenalin increases the heart rate, blood pressure, the rate of breathing, but decreases the blood flow to essential areas like stomach and intestines, thus preparing the individual for either fight or flight.
Today, our stresses are hardly ever physical. Most of the stress faced by youngsters is related to their jobs, finances, relationships, health etc. We cannot really fight or run from them physically. But our body does react the same way as it did thousands of years ago, by secreting adrenaline and cortisol hormones.
Apart from the hormonal influences, chronic stress also causes people to adopt poor habits like neglecting their health, physical inactivity and overeating, which in turn are proven risk factors for cardiovascular diseases.
Worse still, some end up resorting to alcoholism or smoking to “manage” their chronic stress, which amplifies their cardiac risk.
Stress cardiomyopathy — the “broken heart” syndrome
Stress cardiomyopathy also referred to as “broken heart” syndrome, is extremely rare. In this condition, intense emotional or physical stress can cause rapid and severe heart muscle weakness. Common stressors are profound grief, fear, anger, and frustration. It can also occur following numerous physical stressors to the body such as stroke, seizure, or any other kind of severe physical trauma.
Superficially, the condition is similar to a heart attack, with chest pain and slight changes in the ECG. The good news is that in these patients the angiogram screening is normal and the muscle weakness is only temporary. In most patients, the heart completely recovers within a couple of weeks and there is no permanent damage.
How do you deal with stress?
Occasional and small levels of stress can be useful. It can help us stay focused and alert, and help us achieve a target. For example, if you have to finish some important work, the situation can be stressful. But the stress you feel stimulates you to meet the deadline.
However, prolonged or severe stress must be identified and taken care of as it becomes counterproductive and detrimental to one’s health.
Identifying & modifying triggers
The first step in treating stress is to identify it and accept it. Many youngsters are in denial mode for a long time before they break down physically and emotionally. The second step is to identify stressful triggers and check if you can modify them.
Losing a loved one, losing your job, going through a divorce, or having a baby can all be stressful. Discuss your situation with your friends and family. They may be able to provide you with practical and emotional support. Even taking a vacation or taking up a hobby may help. While medications are useful, they are less effective in tackling stress.
Relaxation techniques
Learning how to relax is a great way to cope with stress. Once you’re used to doing it, it will make a difference to your mood and your energy level. It can also help prevent common mental health problems including depression.
Relaxation is more than just sitting back and being quiet. It’s an active process that calms your body and mind. You should experiment and check what works for you. Yoga, walking, cycling are great methods which also reduce the heart attack risk.
Conquering stress
The key to conquering stress is not to avoid it — we can’t, but to cope with it in a calm and methodical way. Relaxation techniques, healthy work-life balance and social support go a long way in tackling this slow killer. A healthy heart needs a healthy mind.
(The author is a consultant cardiologist at Frontier Lifeline Hospital, Chennai.)