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Stress and Your Heart Kelleen Fitzgerald, MD
March 14, 2015
The Atlanta Internists, LLC
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What is stress?
Physiological/emotional response to a threat.
STRESS
Acute stress: “Fight or flight” Energy mobilization
Stimulates the Hypothalamic-Pituitary Axis and the Sympathetic Nervous System.
The Atlanta Internists, LLC 2015
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• SNS • HPA
Brain
• Vascular function
• Immunity • Coagulation • Glucose
Regulation • Blood pressure • Heart rhythm
Physiologic effects
• Sleep • Relaxation • Positive
emotions • Resilience • Resources
Recovery
• Hypertension • Heart attacks • Stroke • Diabetes • Obesity • Mood-anxiety
disorders • Sleep
disorders • Cancer • Dementia
Disease
Health Behaviors Exercise
Healthy Diet Stress Reduction Habits
Health Behaviors Smoking Poor diet
Sedentary Lifestyle
The Atlanta Internists, LLC 2015
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What is Acute stress? STRESS
Acute Anger Interpersonal conflicts Sports matches Traffic
The Atlanta Internists, LLC 2015
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What is Acute stress? STRESS
Social/Evaluative Threat Performance Rejection Discrimination
The Atlanta Internists, LLC 2015
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What is Acute stress? STRESS
Acute bereavement Trauma
Assault, abuse Witness to violence
Natural/Environmental disasters Katrina Earthquake
The Atlanta Internists, LLC 2015 Mayo Clinic Proceedings, Vol. 89, Issue 4, p472–477
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Twenty-four–hour ambulatory systolic blood pressure (SAP; top line [solid], top panel), mean arterial pressure (MAP; middle line [dashed], top panel), diastolic blood pressure (DAP; bottom
line [solid], top panel), and heart rate (HR; dashed line, middle panel) tracings obtained for subject on March 26 and 27, 1998.
Gianfranco Parati et al. Hypertension. 2001;38:1093-1095
Copyright © American Heart Association, Inc. All rights reserved.
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What is Chronic stress? STRESS
Childhood Adversities Occupational Caregiving Burdens
The Atlanta Internists, LLC 2015
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What is Chronic stress? STRESS
Socioeconomic Social/Lack of emotional support Marital/Relationship Personality Negative Emotions
The Atlanta Internists, LLC 2015
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• SNS • HPA
Brain
• Vascular function
• Immunity • Coagulation • Glucose
Regulation • Blood pressure • Heart rhythm
Physiologic effects
• Sleep • Relaxation • Positive
emotions • Resilience • Resources
Recovery
• Hypertension • Heart attacks • Stroke • Diabetes • Obesity • Mood-anxiety
disorders • Sleep
disorders • Cancer • Dementia
Disease
Health Behaviors Exercise
Healthy Diet Stress Reduction Habits
Health Behaviors Smoking Poor diet
Sedentary Lifestyle
The Atlanta Internists, LLC 2015
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stress.org/wp-content/uploads/2011/11/Effects-of-Stress.pdf
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stress.org/wp-content/uploads/2011/11/Effects-of-Stress.pdf
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stress.org/wp-content/uploads/2011/11/Effects-of-Stress.pdf
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stress.org/wp-content/uploads/2011/11/Effects-of-Stress.pdf
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stress.org/wp-content/uploads/2011/11/Effects-of-Stress.pdf
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stress.org/wp-content/uploads/2011/11/Effects-of-Stress.pdf
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Four types of allostatic load.
Bruce S. McEwen Physiol Rev 2007;87:873-904
©2007 by American Physiological Society
Exaggerated reactivity Anger PTSD
Prolonged Response Rumination Worry
Blunted Reactivity Depression Obesity
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• SNS • HPA
Brain
• Vascular function
• Immunity • Coagulation • Glucose
Regulation • Blood pressure • Heart rhythm
Physiologic effects
• Sleep • Relaxation • Positive
emotions • Resilience • Resources
Recovery
• Hypertension • Heart attacks • Stroke • Diabetes • Obesity • Mood-anxiety
disorders • Sleep
disorders • Cancer • Dementia
Disease
Health Behaviors Exercise
Healthy Diet Stress Reduction Habits
Health Behaviors Smoking Poor diet
Sedentary Lifestyle
The Atlanta Internists, LLC 2015
Wear and Tear
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Apply the Hypothesis
• Hypertension • Stroke • Athersclerosis • Myocardial ischemia
- Induced with physical stress testing
- Psychological stress test
• Increased heart rate • Increased blood pressure • Constriction of blood vessels
SNS stimulation
The Atlanta Internists, LLC 2015
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Takotsubo Cardiomyopathy An Example
• Triggered by emotional stress • 90% of cases in women • Severe, reversible heart muscle dysfunction • Ballooning of apex of heart on
echocardiogram • High plasma catecholamines (SNS hormones)
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Stress Reduction • Exercise (ideally 3 hours a week) • Daily relaxation
- Yoga/Tai Chi/meditation
• Positive self talk • Find purposeful pleasure
- Hobbies - Social interaction
- Music/nature • Proper Sleep Hygiene
- Avoid electronics before bed.
- Avoid Caffeine and Nicotine
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• Decreased Blood Pressure • Improved Glucose tolerance • Improved Lung function • Decrease in Inflammatory
markers • Decreased Anxiety • Decreased Depression • Reduce Pain sensitivity
The Atlanta Internists, LLC 2015
Benefits of Relaxation