Stress and the Heart. Kim A. Poli MD, FACC Assistant Professor of Medicine Division of Cardiology, Albany Medical Center

Transcription

1 Stress and the Heart Kim A. Poli MD, FACC Assistant Professor of Medicine Division of Cardiology, Albany Medical Center

2 Thoughts in your mind have made you what you are, and thoughts in your mind will make you what you become. Geraldine Ponder

3 Coronary Heart Disease (CHD): Atherosclerosis/Heart Attack Stress increases risk of developing CHD Stress leads to worsening of existing CHD Stress Induced Cardiomyopathy (Takotsubo CM) Mimics heart attack; normal coronary angiogram 1-12% of patients diagnosed with heart attack

4 Mental Stress Physical Stress Environmental Stress

5 Stress Triggering CHD Natural/man-made disasters (earthquake, war or intense excitement (major sporting evts) Emotional trigger at population level. Morning/Awakening Peak Occurrence for Heart Attack, and Sudden Cardiac Death Type A Behavior Pattern Individual experiences of acute emotional triggers Death, Divorce, personal/family illness, job crisis, children Women; Increase sensitivity to frightening/stressful situations

6 Psychosocial Risk Factors For CHD Depression Anxiety Anger/hostility (vs. Type A) Social isolation/ lack of social support vs. Classical risk factors: Age, Hypertension, Smoking, Cholesterol, Diabetes, Family Hx of CHD, postmenapausal

7 Physiology of Stress on Heart Surges in Sympathetic Nervous System (SNS) activation increase in HR, BP and cardiac output. Blood vessels constrict/ spasm; decrease Oxygen rich blood flow to heart rupture of plaque Substances Circulating in blood Promote clotting, obstruction of blood flow Inflammatory responses leads to atherosclerosis, plaque Risks of Physical exertion much greater in those who are normally inactive vs. those who exercise regularly (SNS+)

8 Wikipedia 9/26/2007

9 Mechanism of Emotional Stress in Increasing Heart Attacks Hostility: stimulation of SNS Acute Mental Stress: Prolonged endothelial dysfunction in healthy people Depression: lack of anger release Increase Cortisol levels Changes in platelet function which causes increase blood clot formation

10 Negative Coping Behaviors during Stress Increase in etoh and food consumption correlates with home/work stress Eating more atherogenic foods also correlated to home/work stress Obesity results in Hypertension and Diabetes and increase CHD Smoking & Sedentary life style Avoidance & Denial

11 Management of Stress Exercise: Cardiovascular- muscular strength training, endurance Meditation/Biofeedback Yoga: focus on flexibility, stretching and mindbody awareness through Breathing Decrease SNS activation, Increase Parasympathetic stim. Regulation of Hypothalamic-Pituitary-Adrenalcortical stim. Decrease in inflammatory markers in CHF pts, increase exercise capacity

12 Yoga Helps cultivate self control, concentration and Patience Hatha or Restorative Yoga: Gentle postures in standing, seated and supine positions w/ breathing exercises, meditation and visualization Mind-Body awareness: Notice how events, interaction, emotions affect onesself. Once aware you can choose your response.and help balance emotions and physical response.

13 Managing Stress and CHD Behavioral treatment; counseling, support groups Exercise/Cardiac Rehabilitation w/ psychosocial interventions Mind Body Exercise: to improve long term adherence to healthy behavior and improve stress management.

14 Importance of Prevention Most deaths from CHD occur before any acute therapy can be given (SCD) Genetics account for 20% of CV risk; aprox. 80% Epigenetics (lifestyle & environment) Prevention is less costly

15 Remember Stress is not solely due to external factors Stress largely results from how your mind interprets a situation Stress is communicated directly to the body

16 Conclusions: Stress Control Physical Activity Recognize Stress Triggers First step to control and change your reaction to it. Relaxation techniques; breathing, visualization,writing Medication & Compliance Ask for help, connect w/others

17 Take Care of Yourself. Your family will thank you!