Stress is a part of life and it affects us all. Everyone experiences stress in different ways, and react to it differently as well. What might appear as a stressful situation to one, might be of little concern to another. 

But stress  is not always bad; useful stress or eustress challenges you to push boundaries, keep things exciting, and encourages you to do better. Moving to a new house, going to college, or getting married might seem like stressful situations, but in reality, they help you keep going in life. 

Distress though, does the opposite. A tense and unhappy domestic situation, financial problems, or a negative work atmosphere can be sources of distress and affect you mentally as well as physically. While the body can handle some amount of stress, chronic stress or long-term stress can give rise to a variety of health problems. It can also impact sleep, appetite and mood. 

But can stress also cause a heart attack?

Stress and your heart

There is no doubt that stress can show up as a physical symptom or worsen existing conditions. While there are some common symptoms of stress such as insomnia, headache, fatigue, sweating, anxiety, and stomach problems, chronic stress has also been linked to increased risk of cardiovascular diseases (diseases of the heart and blood vessels). This risk is  at par with other risk factors such as smoking, high blood pressure, or cholesterol levels. 

A stressful situation can set off a series of events, which affect the blood flow as well as the functioning of the heart. Stress puts you in a fight-or-flight response, that helps you deal with a challenging situation. Your body produces stress hormones, such as cortisol and adrenaline that increases your heart and breathing rates, and causes tense muscles.

Chronically high levels of cortisol predispose an individual to higher levels of cholesterol in the body, weight gain, problems with metabolism of glucose resulting in a diabetes-like state, mental health problems like depression and weakening of muscles including those of the heart

Even though these problems evolve over a period of time, the resultant changes create conditions ideal for an impending heart attack. Many people resort to unhealthy lifestyle habits such as drinking alcohol, smoking, or overeating as a way  of coping with stress. These can also cause adverse effects on heart health. All these factors can cause lifestyle diseases such as diabetes, hypertension, metabolic syndrome etc. In fact, these are amongst the leading causes of heart attacks. 

Is stress directly linked to heart attack?

Stress cannot directly cause a heart attack. However, a sudden, acute form of severe stress can trigger an event that feels just like a heart attack. This condition is known as a broken heart syndrome. Its symptoms are similar to those of a heart attack. Think chest pain, sweating, palpitations, and shortness of breath. The usual triggers for this condition are sudden emotional stress like death of a loved one, intense anger, or a deep loss. A small proportion of cases are due to physical problems like seizures,  acute attack of asthma, or side-effects of certain medications. However, this condition forms only 2% of cases of heart-related events and is life-threatening in very rare cases . 

Who is more prone to a stress-related heart attack?

1. People working in high stress conditions like critical care, air traffic control, firefighting

2. People with a so-called “type A” personality, often known as high achieving workaholics, who are restless and find it difficult to stop working even if they have achieved their goals. Studies have shown that these people have twice the chance of getting heart attacks due to higher stress levels than those with a relaxed and patient type B personality

3. Those suffering from a disease called Cushing’s syndrome, where the body has chronic high levels of steroids

4. People taking steroids over long periods of time for management of certain disease conditions 

Can we reduce the risk of a heart attack by reducing stress?

The one word answer is, definitely. A reduction in stress levels tends to reverse or diminish most of the physical and biochemical changes that stress causes in the body. 

Stress management techniques aim to make the parasympathetic (rest and digest) system of the body stronger over a period of time. This reduces heart rate, makes the heart muscle stronger and more efficient. It also relaxes the blood vessels all over the body, which leads to increased blood flow to the heart and other vital organs. 

Stress management, along with lifestyle modifications like dietary changes and regular exercise, help in reducing weight, lowering levels of glucose and cholesterol in the blood, improve mood, and have a positive effect on overall health and wellbeing. 

Techniques of stress management

1. Seek professional help if you suffer from any symptoms of stress
2. Medications are usually not beneficial for management of stress. However they may be prescribed for managing acute immediate effects of anxiety or depression and should be taken only under medical supervision
3. Meditation and relaxation techniques are known methods of “calming the nerves”
4. Maintaining healthy relationships with friends and family
5. Healthy balanced diet, reduced consumption of caffeine
6. Avoid smoking, popping in tranquilisers, or consumption of alcohol for coping with stress
7. Regular exercise increases the levels of the feel-good chemicals called “endorphins” in the body, thus helping not only in physical wellbeing, but also enhancing the mental health of an individual.
8. Stress management at the workplace — wage management, healthy interactions with co-workers, time management, workload management are few techniques suggested by NIOSH under its Total Worker Health approach .

Heart health is closely linked to stress management. Even though stress is an indirect factor in the triggering of a heart attack, its management definitely reduces the chances of getting one. A stress-free heart is a healthy heart. 

References
1. Marmot MG. Does stress cause heart attacks? Postgrad Med J 1986; 62: 683–6.
2. Burch K. Stress Can Cause a Cardiac Event That Resembles a Heart Attack. The American Institute of Stress. 2020; published Apr 3. https://www.stress.org/stress-can-cause-a-cardiac-event-that-resembles-a-heart-attack#:~:text=While%20stress%20can’t%20directly,and%20how%20to%20manage%20it (accessed May 4, 2021).
3. Friedman M, Rosenman RH. Association of specific overt behavior pattern with blood and cardiovascular findings; blood cholesterol level, blood clotting time, incidence of arcus senilis, and clinical coronary artery disease. J Am Med Assoc 1959; 169: 1286–96.
4. McLeod S. Type A and B Personality. Simply Psychology. 2017. https://www.simplypsychology.org/personality-a.html (accessed May 4, 2021).
5. What Is Total Worker Health? Centers for Disease Control and Prevention. https://www.cdc.gov/niosh/twh/totalhealth.html (accessed May 4, 2021).
6. Stress and Heart Health. American Heart Association. https://www.heart.org/en/healthy-living/healthy-lifestyle/stress-management/stress-and-heart-health (accessed May 4, 2021).