How your emotions hurt your heart

Research confirms that mental stress and anger affect the performance of the heart – and brain activity may predict heart problems.

Yale University study results published in the Journal of Cardiac Failure show that patients with damaged or weakened hearts who experienced anger in the week prior to the laboratory tests recorded worse results than calmer individuals with the same condition.

A separate study from the American Heart Association (AHA) found adults with coronary artery disease people who were under mental stress “experienced more severe chest pain”.

Life-threatening cardiovascular disease occurs when the heart is damaged or weakened. It can lead to the heart muscle pumping out a lower volume of blood with each contraction.

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The Yale study measured the ability of the heart to relax and refill between muscle contractions – the diastolic function.

Patients who reported experiencing anger in the week prior to the laboratory mental stress test exhibited worse resting diastolic pressure.

Most patients also exhibited “stress-provoked changes in diastolic function”.

“Mental stress is common in patients with heart failure due in part to the complexities of disease self-management, progressively worsening functional limitations and frequent symptom exacerbations and hospitalisations,” said lead author Kristie Harris, a postdoctoral associate in cardiovascular medicine at Yale.

“We have evidence that patients who experience chronically elevated levels of stress experience a more burdensome disease course with diminished quality of life and increased risk for adverse events,” Dr Harris said.

“Factors such as mental stress and anger often go unrecognised and are under-addressed,” said Matthew Burg, a Yale clinical psychologist and senior author of the study. “This study contributes to the extensive literature showing that stress and anger affect clinical outcomes for patients with heart disease, adding chronic heart failure to the list that includes ischaemic heart disease (narrowed arteries) and arrhythmic disease.”

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Dr Burg said that further work was needed to determine whether stress management could improve outcomes.

The AHA study published in the Circulation: Cardiovascular Imaging journal took brain scans of 148 adults with coronary artery disease. Those under mental stress showed increased activity in the inferior frontal lobe of the brain and experienced more severe chest pain (angina).

The scans measured activity in the inferior frontal lobe of the brain, which is responsible for emotional regulation and stress.

Participants with more severe chest pain also registered greater activity in the inferior frontal lobe while stressed.

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“We were surprised by the strength of the relationship between the level of activity in this brain region and the frequency of chest pain reported,” said lead investigator Amit J. Shah, M.D., MSCR, in a news release.

He said the top three factors that explained angina frequency were stress-related, including brain activation, and symptoms of depression and post-traumatic stress disorder.

“This is surprising because when we manage angina in clinical settings, we normally do not consider stress as an underlying factor, and rather focus on blood flow in the heart.”

A previous observational study done by the AHA concluded that depression may increase a person’s risk of having heart disease or stroke.

“Cardiovascular diseases are impacted by and related to a variety of aspects of health and wellbeing, including mental health,” said study author Yosef M. Khan, M.D., Ph.D., national director of health informatics and analytics for the American Heart Association.

“We found that the level of depression was strongly tied to living with heart disease and stroke, even after accounting for other factors that could impact risk, including variables of age, income, education, sex and race/ethnicity.”

Regardless of its severity, depression increased the chances of someone developing heart disease by 24 per cent.

“The implications of such an increase are vast,” Dr Khan said.

“By understanding the relationship and degree of impact, we can properly identify, prevent, treat and create policies and strategies to help decrease cardiovascular diseases and improve lives by tackling mental health and heart disease together.”

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