Sudden stress can stun your heart

Physicians have been aware that traumatic events could result in a small but real number of patients suffering from sudden cardiac death, classic heart attack symptoms or abnormal cardiac rhythms. We’ve seen it after natural disasters such as earthquakes, as well as after an individual experiences some traumatizing event, most commonly the unexpected death of a loved one.

This study is the first to provide us with evidence of biochemical markers indicating there are actual physical changes taking place in the body due to severe emotional trauma.

Women are more susceptible
Though we see this syndrome in men and women, women tend to be more susceptible to the effect of sex hormones on sympathetic nervous system activity and coronary spasm. The typical victim is a woman, over age 50, usually postmenopausal, with no previous cardiac disease who has undergone a “lifetime” crisis.

More than 70 percent of the time the precipitous event is a death. Patients experience sudden chest pain and shortness of breath. Some are in profound shock with very low blood pressure. Their hearts pump at about a third of the normal capacity, similar to severely ill heart failure patients.

Study patients had no permanent damage
These patients in the New England Journal of Medicine and the 22 women studied in the Circulation paper all had abnormal EKGs, some had abnormal serum markers, but when their coronary arteries were examined, only one showed evidence of clinically significant coronary disease. All of the patients fully recovered with no heart damage within a few days.

When the broken heart syndrome patients were compared with heart attack patients, the remarkable difference—aside from the absence of coronary disease—was the high level of stress hormones in their systems. These hormones—the catecholamines, which include adrenaline, noradrenaline and others—prepare our bodies to meet emergencies such as cold, fatigue and shock.

They are responsible for the 'fight or flight' response that enabled our ancestors to escape predators and other dangers. However, new research shows that these chemicals can also be temporarily toxic to the heart, stunning the muscle and producing the symptoms these patients experienced.

Heart stunning should be treated
If this heart stunning is not treated, some people may die because the pumping action of the heart is so weakened. That's why it's essential for individuals who are experiencing these symptoms to seek emergency medical help immediately. There was a time when physicians minimized these physical reactions to trauma, attributing the symptoms to psychological causes. This study clearly shows the heart is undergoing physical changes that need to be assessed and treated immediately.

When stress is chronic
Although this syndrome is a result of an acute stressful event, there is evidence that chronic stress and long-term anxiety also increase the risk of heart disease. There are several ways this can happen. People who experience a lot of depression and anxiety may be less likely to practice heart-healthy lifestyle habits such as exercise and weight control than calmer individuals. They also may be more likely to smoke.

Chronic stress also predisposes people to cardiac arrhythmias and has a direct effect in advancing atherosclerosis, the molecular basis for heart attacks. Chronic anxiety, which results in the continuous elevation of catecholamines, can also lead to the development of cardiac risk factors such as high blood pressure, diabetes and high cholesterol.

For these reasons, it's important for people to get help for chronic anxiety and stress since research also shows that management of long-term anxiety can lead to better management of cardiac risk factors and the subsequent decrease in the risk of coronary disease. It is critical for all individuals, especially women, to know their risk factors for heart disease and to take charge in controlling them.

Take action
It is important for you to be sensitive to what's happening to your body. If you notice subtle feelings of being unwell, it is very important to get checked out right away. Seek emergency care immediately when experiencing any of the signs or symptoms of a heart attack. Get a second opinion if you feel that your symptoms are not being taken seriously and be assertive in seeking help.

Dr. Safdar is the co-director of the Yale-New Haven Hospital Chest Pain Center and an assistant professor of emergency medicine at the Yale University School of Medicine.