Winter 2013
Ask the Experts: Stress and Heart Attacks

Steven Kunkes, MD

Can too much stress cause a heart attack?

Cardiologist Steven Kunkes, MD, responds:

It has long been suspected that stress can contribute to heart attacks, but this has been a bit difficult to prove.

The definition of stress differs among experts, but scientists consider some things to be universally stressful. These include divorce or separation, leaving a job or work environment, personal illness or illness in a close member of the family, failure of a business and intense conflict or violence within a family.

There are some strong clues that these can hurt the heart. One is that heart attacks and deaths from heart problems often occur in the early morning when the sympathetic nervous system is most active. The sympathetic nervous system sends out stress hormones that many of us call the “fight or flight” response. These same hormones—released when the body is tense—increase the heart rate, raise blood pressure, make blood more sticky and also increase the tone of arteries which can make them smaller and less able to carry oxygen. All of these responses increase the work of the heart and can contribute to the rupture of cholesterol or atherosclerotic plaque, which can cause angina, arrhythmia or heart attack.

Another clue is that the incidence of heart problems and cardiac death increase in the months after natural disasters such as earthquakes and hurricanes—both very stressful.

Additionally, almost half of all people who have heart attacks describe that they were upset just before feeling their heart attack symptoms.

Certain personality types—those who are hostile, angry, cynical or stressed out—seem to be more prone to heart attacks.

Finally, people who are under stress tend to have additional habits that increase their risk for heart attack. For example, a stressed person may eat more comfort foods or stop exercising or drink too much alcohol.

One type of heart trouble, called takotsubo cardiomyopathy, or broken heart syndrome, has been linked directly to stress or severe emotional trauma. People experience chest pain as part of the heart temporarily enlarges and does not pump well. The condition is often reversible after the stressor is relieved.

It is possible to prevent stress from triggering a heart attack in someone who is already at risk. First, pay attention to the traditional risk factors for a heart attack: stop smoking, keep blood pressure and cholesterol levels in check and get screened and treated for diabetes. Second, figure out ways to gain control over the stressors in life. (For example, if your weight is causing your stress, follow a healthy diet and keep a goal weight in mind.) Third, start an exercise program (such as walking) and reserve part of every day for this activity. And fourth, participate in a social activity on a regular basis. Participation in volunteer activities and religious groups, as well as caring for a pet, have been shown to decrease stress levels.

The stress in your life may be affecting your heart. Speak with your doctor. He or she can help determine which interventions (lifestyle/medical) may decrease your risk of heart problems and help you enjoy life.