Can stress cause a heart attack? This is a question that cardiologist, Dr Annari van Rensburg, who practices at Netcare Blaauwberg Hospital in Cape Town, is commonly asked. She says that the answer is complex but also fascinating, and has considerable relevance for Heart Awareness Month.
Dr Van Rensburg shared some of her insights on this subject, which she believes “requires much greater awareness among both the general public and medical practitioners in South Africa, as it could potentially assist in saving lives.”
What is a heart attack?
Dr Van Rensburg says that most of us have heard of the term ‘heart attack’, but relatively few people understand the mechanics involved. A heart attack refers to a blockage in one of the coronary arteries, which are blood vessels that supply blood to a person’s heart. Such a blockage within the coronary arteries can result in a part of the heart muscle being deprived of blood and oxygen, which, in turn, causes part of the heart muscle to die.
“The blockage typically starts off as a narrowing in a coronary artery, known in medical terms as stenosis. It may be as a result of damage caused to the cardiovascular system by conditions such as high blood pressure and diabetes. An unhealthy diet and lifestyle that includes activities such as smoking, can also considerably increase the risk of developing this narrowing condition,” Dr Van Rensburg observes.
“Damage to an artery can create a ‘foothold’ for cholesterol and fats to build up on the coronary artery wall, resulting in it becoming diseased and weakened. If a little tear occurs in this cholesterol build-up, which is known as a plaque, it can expose your blood to its abnormal contents and lead to the formation of a blood clot. Such a clot may block the already partially narrowed blood vessel, causing a heart attack.”
Pic: Dr Annari van Rensburg is a cardiologist who practices at Netcare Blaauwberg Hospital in Cape Town.
Stress and the cardiovascular system
According to Dr Van Rensburg, stress itself has not been shown to significantly raise the individual’s cholesterol levels, nor directly damage coronary arteries. Stress can, however, negatively affect many people’s behaviour and lifestyle which in turn can increase one’s risk of developing heart disease.
“Individuals with high stress levels are likely to exercise less and they often try to ‘self-manage’ their stress through over-eating, a poor diet and smoking. Over time, such an unhealthy diet and lifestyle can damage the blood vessel walls, causing them to become diseased, and substantially increase the risk of the person suffering a heart attack.”
Broken heart syndrome
“It should also be emphasised that while stress itself does not directly damage the coronary arteries, it can result in another condition known as stress cardiomyopathy, which is sometimes also known as ‘broken heart syndrome’.
“Stress cardiomyopathy is a condition where extreme emotional or physical stress results in a critical weakening of the heart muscle. It can present much like a heart attack, and be just as life threatening if it is not managed correctly.
“The condition was first documented in Japan in 1991 but has only been recognised within the Western world since 1997. As a result some local doctors may not yet be familiar with it. It is estimated that two to three percent of cases that would previously have been thought to be heart attacks, are actually stress cardiomyopathy. This disease typically affects middle-aged women, but can affect anyone,” advises Dr Van Rensburg.
Looks like a heart attack
Dr Van Rensburg says patients with stress cardiomyopathy typically present with chest pain after an emotionally or physically stressful incident. “The incidents themselves can vary quite substantially, and be something as stressful as a divorce, or as mundane as a verbal altercation with a neighbour.”
“The pain from cardiomyopathy is often similar to that of having a heart attack, and a patient’s blood tests might also indicate a heart attack. A major difference, however, is that stress cardiomyopathy is not caused by coronary artery disease. Furthermore, unlike a heart attack which kills heart muscle, it is thought that cardiomyopathy involves the heart cells being stunned by hormones such as adrenaline.”
“Doctors should therefore be aware that treating these patients in the same way as those who have experienced a conventional heart attack — for which strong blood thinners are often prescribed — can actually increase their risk of suffering complications.”
The importance of appropriate management
According to Dr Van Rensburg, the good news is that while stress cardiomyopathy can be life-threatening, particularly in the first few days after an ‘attack’, it is often completely reversible with the appropriatesupportive care, including the management of high blood pressure, while the heart is enabled to recover.
“The provision of emotional support and stress management can also play an important role in supporting the longer-term health of these patients,” she observes.
“To sum up, managing both long-term stress, as well as acute stressors, is very important for heart health. It simply does not pay to use stress as an excuse for not getting around to exercising and for failing to adopt healthier eating habits. Those who become worried about chest pain would be well advised to see their doctor or cardiologist straight away. You only have one heart, so take good care of it,” Dr Van Rensburg advises.
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