Stress and the heart

Although I used to work as a general hospital psychiatrist, I doubt if I fully appreciated the power of the mind-body connection till I became ill myself. Last year, during a prolonged period of anxiety and exhaustion due to my husband’s heart attack and cardiac surgery followed by my mother’s bowel obstruction and fatal stroke, I started to experience alarming episodes of fast irregular heartbeat, faintness and tightness in the chest, accompanied by high blood pressure. Other symptoms around this time included weight loss, insomnia, spells of fatigue, hot flushes and cold chills. Medical investigations showed a few minor abnormalities which were not regarded as very significant.

The episodes of tachycardia and hypertension continued to happen after everything else had settled down, as if they had taken on a life of their own. My husband, who has now made an excellent recovery himself, believes that being in the “front line” of so many traumatic events caused me to develop a variant of the condition described in the First World War as “shell shock” or “soldier’s heart”. Many other diagnostic labels were suggested from various sources: “broken heart syndrome” “post-traumatic stress disorder” “atypical depression” “autonomic neuropathy”. The diagnosis from a recent specialist consultation was “paroxysmal hypertension” also known as “pseudopheochromocytoma” and preventive treatment with beta-blocking and alpha-blocking drugs has been successful so far. From being barely able to cope with daily activities a few months ago I am now almost back to my usual self, but with an increased awareness of the fragility of life and health and the unpredictability of the future.

While the type of stress-related syndrome described above is not life-threatening, there are more serious cardiovascular conditions that can be partly attributed to stress. I am not an expert in “psychocardiology”, but my experiences led me to look through the research literature and I found some well-established links. These probably stem from a complex interplay between biological and lifestyle factors: over-secretion of stress hormones such as adrenaline and cortisol, and lifestyle habits such as smoking, drinking too much alcohol, lack of exercise, lack of sleep, and general neglect of self-care. For example: Coronary heart disease, building up gradually over the years, is associated not only with the well-known physical risk factors such as hypertension and high cholesterol but with psychosocial ones: long term difficulties such as being unemployed, lonely, unhappy in marriage or at work, suffering from anxiety or depression and according to some studies the personality characteristics of impatience, competitiveness, hostility and suppression of emotion. Acute traumatic events, such as experiencing the death of a loved one or being involved in an accident, can precipitate angina, arrhythmias or heart attacks (myocardial infarction caused by coronary artery blockage) in predisposed people. The risk of death from heart disease  is increased during the first year of widow(er)hood. Those who survive a heart attack, and become anxious and depressed afterwards, have a worse medical prognosis than patients whose mental health is not so affected.

Mind-body connections, though widely accepted in theory, do not always have much impact on clinical practice. It is perhaps inevitable that, in the highly specialised world of hospital medicine and surgery, there tends to be a narrow focus on the diseased part rather than a more holistic view. Staff who are expert in technological procedures may not have the time or skill to deal with the lifestyle and psychological aspects of illness, for example many cases of depression and anxiety on cardiology wards are not recognised or treated.

Most cultures regard the heart as the seat of emotion, and in the energy medicine traditions of the East the “heart chakra” is associated with love, compassion, empathy and forgiveness. Can cultivating such qualities protect against heart disease? Not only are they difficult to measure, but most studies in medicine and psychology focus on negative factors rather than positive ones. However, there is evidence that life satisfaction, optimism, and happiness lower the risk. Owning a dog, which besides encouraging regular exercise provides a reliable source of unconditional love, is also conducive to heart health. Cats apparently have less cardioprotective effect, but they do know how to demonstrate the art of relaxation.

Homer supine