How Stress Affects Your Heart

Your body and brain have a physical response to every stressful situa­tion, from rebellious teenagers to importunate clients to the nonstop ringing of a telephone at the office. And no two women respond in the same way to all stressful events. What may be a source of emo­tional excitement for you may be a source of abject terror for your best friend. Although this response can vary in intensity, the physical symptoms characteristic for one woman will predictably happen again and again during “tense” moments. Yet you can learn to man­age your response to stress and to lessen its negative, physical effect.

Many of my patients want to know how stress actually affects the heart. I explain that it starts with the autonomic nervous system, an unconscious part of the nervous system that has two branches, the sympathetic and parasympathetic. These branches work together to control some of the involuntary activities of the body, producing chemicals that direct those activities. The sympathetic branch nor­mally releases adrenaline, but under unregulated stress it produces excessive levels, which cause your heart rate and blood pressure to soar. Most people have felt palpitations, a strong heartbeat or a rac­ing pulse, at times, which indicate an increase in your blood pres­sure. When stress continues without letting up over a long period of time, your blood pressure stays elevated, and you may develop hy­pertension. Another silent form of heart disease, hypertension can become so serious that you need medications, along with a better diet and other lifestyle changes, to get your blood pressure back to normal. So it’s better to prevent hypertension from developing. If you are experiencing a few of the stress characteristics listed in the box, chances are good that your level of stress is excessive.

COMMON STRESS REACTIONS

• Anger

• Anxiety

• Back pain

• Chest tightness

• Depression

• Headaches (including migraines and tension headaches)

• Heart palpitations

• Irritable bowel syndrome

• Inability to relax at night

• Inability to concentrate

• Increase in blood pressure

• Irregular menstrual periods

• Loss of sexual desire

During stressful moments, adrenaline, the body’s main stress-related hormone, is released by the autonomic nervous system. This adrenaline release sets up a whole cascade of reactions, including in­creased heart rate and blood pressure and stimulation of platelets (blood-clotting cells). Stress hormones can damage blood vessels by altering their flexibility and making them more vulnerable to plaque disruption. Because every woman responds to life’s stressors differently, our emotions profoundly influence our hormonal production. The way we perceive a problem, and the amount of control we have to change it, influences how we cope with it. The kind of personality we have also affects how our body and its internal systems respond. Let’s look at how these factors dictate our unique stress responses.

Perception

Of the four contributing factors to stress, perception is absolutely the most important. If you perceive that something is a threat to you, it triggers an adrenaline surge that puts your body on “red alert.” To some extent, a thing is a threat if it is perceived that way. For exam­ple, perhaps your best friend looks forward to going for a ride on her motorcycle. For her, this is a great experience and a form of emo­tional excitement. For you, the thought of being on two wheels in traffic may cause great anxiety. Your friend may also love speaking in front of people at work, while for you giving a talk or presentation is upsetting. The environmental trigger is identical, but you and your friend perceive the situation in entirely different ways.

Control

When you perceive that you no longer are in control, your emotional state can turn anxious. Quite honestly, the physiological line be­tween positive emotional excitement and anxiety is very fine. I tell my patients that control is like a strong bridge that protects you from the turbulent rapids below. River rapids can be fascinating to watch when you are thirty feet above them, safe and sound, but if the bridge over them is shaky or has holes in it, they can become terrify­ing. In that case, your control is weakened, producing stress. To some extent, being in control protects you from stress. If you feel you’ve lost control in your life, you feel helpless and anxious and can develop health problems. Knowing this, you can work to get more control over your life or at the very least over your perceptions and coping style.

Coping Style

Does the slightest irritation get you upset? Does your heart rate soar, and do you perspire profusely? When you are under pressure, does your breathing become rapid and shallow? These are all signs of your particular coping style, another psychological variable that can influ­ence your heart’s health. Some people cope with life’s stressors by staying cool and calm. Some become highly anxious, and some completely deny having any problem at all. Interestingly, when I ask some of my patients about how they cope emotionally, they often say that they are generally very calm—yet test results repeatedly show them to have signs of high anxiety. I interpret this to mean that these women are only out­wardly calm and are repressing, denying, or “stuffing” their feelings.4

Suppressing hostility and anger is specifically associated with in­creased heart disease risk.5 It is very hard on your body and will take a toll on your overall health. In addition, some studies show that an ac­cumulation of the stress hormones may make blood vessels constrict and accelerate the formation of new blockages.

Managing Anger and Stress

Sustained mental stress is as likely as strenuous physical activity to precipitate heart attack in people with heart disease.8 People with type A personalities have twice the likelihood of undergoing a repeat angioplasty than calmer patients.9

The bottom line is that you need to know how you react under stress. You have to recognize what triggers your anger and work ra­tionally to lessen these feelings so that you are not in a prolonged state of stress. You may not be able to change your stressors, but you can learn to alter your response. You want to identify when, where, and why you get angry and then take steps to recognize and deal with your anger before it builds up over time and damages your heart. I’ll help you do this later in Chapter 12.

If you already know that you’re living with a high level of anger, please try to avoid situations that drive up your anger thermostat. Go shopping during a slow time at the grocery store to avoid long lines, for instance, and avoid rush hour on the highway. If your anger is ex­plosive, talk with a counselor about constructive ways of dealing with it before you hurt yourself or someone else. Exercise is an especially effective way to disperse stressful or angry thoughts. It’s hard to stay angry if your mind is focused on pedaling uphill or keeping up in an aerobics class. Besides exercise, one of the best ways I’ve found to manage my own stress is to follow the techniques devised by behavioral psy­chologist Dr. Barrie Guise, who teaches that while we cannot change our personalities or the stress that comes with living, we can modify our response to stress. For example, in any stressful situation, try to learn what you can and cannot control, and accept it. Then learn to Change your response to situations that normally cause great stress such as deadlines, bills, or challenging children.

SEVEN WAYS TO MANAGE ANGER AND STRESS

1. Think rationally: break the stressful situation down into controllable components.

2. Behave assertively but not aggressively.

3. Find support for getting rid of your anger by talking to a friend, a loved one, or a counselor.

4. Learn a relaxation method that you like, such as meditation, prayer, and exercise.

5. Make sleep a priority. When you’re rested, you can see more op­tions to and interpretations of any situation.

6. Increase your physical activity—exercise reduces stress hormones.

7. Seek out humor in your life—laughter also reduces stress hor­mones. Read humor books, collect jokes that you like, and watch funny videos with a friend.

Depression May Be a Risk Factor

Recently, depression has been isolated as a risk factor for the devel­opment of coronary artery disease. Patients who have had a heart at­tack and who also have a serious clinical depression are more likely to die earlier than heart attack patients who are not depressed. De­pression appears to decrease a patient’s compliance with medical ad­vice and instructions, and she tends not to take necessary heart medications, or stick with a healthy low-fat diet and regular exercise program, or quit smoking. Biological factors that we have yet to dis­cover may also affect the depression-heart link. For instance, depression’s effect on the autonomic nervous system may result in lower immune function, and depression may coincide with other chronic illnesses, such as hypertension. Some studies show that depression stimulates platelet activity,11 which makes them stickier, so that they tend to form blood clots, which is the trigger for a heart attack.

It’s not surprising that a woman who has had a heart attack or who has high blood pressure would be somewhat depressed by her

diagnosis. It is certainly a challenge to have to deal with a chronic ill­ness and to make changes in the way you eat and otherwise live your life in order to get healthier. It’s scary, too, to know that you have a condition that may shorten your life. Coming face to face with your own mortality is always a sobering experience.

But please remember that there are things you can do to get bet­ter. You do have control over how you perceive your illness—you can view it as a call to take action to be healthier and live longer. See your heart and body as having sent you a message that it’s time to take care of you.  You can do things that make you feel better and im­prove your heart’s health. Talk to a friend or relative, or a minister, rabbi, or counselor about your feelings so that you isolate what it is that’s depressing you and act to heal that depression. If you have been depressed every day for more than two weeks, talk to your doc­tor or a professional counselor.

One of the best ways to improve your life and health is by being with other women. You can find new ways to exercise and more ac­tivities that you enjoy when you join a group. You can also ask advice for what to do of your doctors, physical therapists, and rehabilitative therapists.

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