Disgust can be deadly. Although rare, cardiologists have identified cases of heart attack that are triggered by bad news or a traumatic event, such as that caused by broken heart disease. This syndrome, called tako-tsubo by the Japanese scientists who discovered it in the 90s, was considered a rare disease at first, but is now known to occur with some frequency and throughout the world. It is triggered when, in a stressful situation, a large amount of a neurotransmitter called catecholamine, similar to adrenaline, is released, which agitates the heart and can break one of its valves. This type of heart disease affects women in 98% of cases. Among them, 2% of heart attacks are caused by an emotional response.
Recently, an article published by the American Heart Association identified a mechanism that may be behind the relationship between emotional outbursts and heart ailments, how unexpected bad news or a scare can change the functioning of blood vessels. At work, a group of young and healthy volunteers were asked to report experiences that had made them angry, anxious or sad, for 8 minutes, while various parameters of their cardiovascular health were measured.
Among individuals who reported experiences that caused them anger, it was observed that the ability of blood vessels to dilate, which serves as a form of cardiovascular protection, was reduced for about 40 minutes, something that is related to an increased probability of suffer a heart attack. This did not happen among those who recalled situations that caused them anxiety or sadness.
The authors, led by Daichi Shimbo, from Columbia University (USA), propose that if these effects of negative emotion are repeated, over time “they can affect cardiovascular physiology, causing irreversible damage.” The results point in the same direction as others who have discovered that, in the hour before a heart attack, the person who suffers it is more than twice as likely to have experienced some type of emotional distress than during the same period of the previous day. .
“The results give clues about how stress alters the protection mechanism of the arteries against the risk of developing atherosclerotic obstructions,” says Manuel Anguita, spokesperson for the Spanish Society of Cardiology. According to the cardiologist at the Reina Sofía University Hospital in Córdoba, this knowledge can be used to develop pharmacological approaches for people with a high risk profile due to stress. This solution would be added to a psychological approach that helps manage stress. “We recommend patients speak with a clinical psychologist to learn how to modulate this reaction to stress. In fact, in cardiac rehabilitation units not only physical rehabilitation is offered, but also psychological rehabilitation,” says Anguita, although he points out that this collaboration between cardiologists and psychologists or psychiatrists “is not yet too developed.”
The study published by Shimbo and his collaborators offers an explanation for a phenomenon observed for a long time. Mental illnesses worsen heart health and the psychological approach is a very useful tool to prevent these effects.
“Scientific studies have shown that patients with untreated chronic depression or chronic anxiety have a significantly increased risk, between 15% and 20%, of suffering from cardiovascular diseases such as myocardial infarction, angina, hypertension and stroke,” points out José Luis Carrasco, director of the Personality Disorders Unit at the San Carlos Clinical Hospital in Madrid. More than the emotional consequences of these ailments, this is due to the fact that they usually have an unhealthy diet, because they eat with anxiety; and, in general, they have difficulties controlling their diet, something that increases the risk of having high cholesterol, suffering from diabetes or having metabolic syndrome.
Mental health and cardiovascular risk
In turn, heart problems also increase the risk of suffering from mental illness. “It is well known that patients with cardiovascular disease, without a history of mental illness, once they have been diagnosed, have two to three times more risk of presenting with a diagnosis of mental illness,” recalls Jorge Pla, psychiatrist at the Clínica Universidad de Navarre. “Those who develop a mental illness also have a higher risk of dying from a cardiovascular cause and a worse evolution of this type of illness if they already had it,” he continues. This increased risk, explains the specialist, suggests that pathophysiological mechanisms could be shared that would explain the possibility of developing both diseases. “In the case of depression, it is known that the psychological stress derived from suffering from a serious illness such as that of cardiovascular origin, and everything that the stress reaction (hypothalamic-pituitary-adrenal axis) implies, can influence the psychological health of the vulnerable patient,” he continues. In addition, some inflammatory changes, which may be present in arteriosclerotic or thrombotic processes, are also detected in patients with major depression. “Changes in the vascular endothelium have also been proposed as a shared mechanism with forms of depression that begin in advanced age and have been called vascular depression,” concludes Pla.
“Patients with cardiovascular diseases also often develop depression, especially those who were previously active, because they have a feeling of loss and are afraid that it will happen again. This can lead to a decrease in physical activity and an increase in negative thoughts,” agrees Carrasco, who points out that in these cases it is necessary to intervene, and that for this there are psychiatry units that team up with cardiology units. They carry out a psychological evaluation of these patients and treat them, generally with psychotherapy, but “also with anxiolytics or antidepressants, which can relieve blood pressure and improve the patients’ quality of life,” he says.
Just as there are people who are prone to some metabolic diseases, some personalities also favor cardiovascular ailments. Very active people, addicted to work, who experience high levels of internal stress. “This emotional stress can be transformed into blood pressure, affecting the fibers of the arteries and the endothelial layer of the blood vessels. There are studies that have shown that chronic stress causes high levels of inflammation and oxidation, especially in endothelial cells, which can lead to the formation of thrombi and, ultimately, cardiovascular diseases,” explains Carrasco. In these individuals, techniques to deal with stress, relaxation or improving interpersonal relationships are effective in reducing their risk levels, but being very busy it is difficult for them to dedicate the necessary time. As in other cases, cooperation between cardiologists and psychiatrists, along with the combination of drugs that help reduce anxiety and changes in lifestyle, can reduce the mortality rate from heart attacks.
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