Women's Heart Advisor July 2014 Issue

Managing Your Stress May Help Your Heart

Response to emotional stress may be linked to coronary artery dysfunction in women; finding ways to overcome stress is critical.

In a fast-paced world, stress and its precedence is a common thread between both women and men. Yet, research has found that emotional stressors—such as those provoking anger and irritability—may cause changes in the nervous system that controls heart rate and triggers a type of coronary artery dysfunction that occurs more frequently in women than men.

The increased rate is due to the fact that coronary artery disease in women tends to be different from men’s, according to a study presented at the American Psychosomatic Society’s annual meeting (March 2014). While the large arteries in women may remain clear, the smaller branches that connect the even-smaller capillaries lose their ability to widen. The result in either blockage of the large arteries or the small arteries not functioning correctly is the same: The heart is starved of oxygen.

While the consequence is the same, it’s clear that there’s a mechanical pathway that differentiates how heart disease affects women, according to Cleveland Clinic psychiatrist Leo Pozuelo, MD.

“When women experience chest pain and reduced oxygen to the heart it may be more caused by microvascular dysfunction due to emotional distress,” says Dr. Pozuelo. “Research is continuing to prove that this is a plausible mechanism that is seen more often in women.”

Understanding a different type of heart disease
Coronary microvascular disease (MVD) is the type of heart disease that tends to impact women more than men—is heart disease that affects the tiny coronary (heart) arteries. When MVD sets in, the walls of the coronary arteries are damaged or diseased. Different from coronary heart disease, where a waxy substance called plaque builds up in the larger coronary arteries, MVD is not caused by a buildup of plaque.

“Microvascular disease, combined with strong emotions or physical stress, causes an increase in heart rate, elevation of blood pressure and release of stress hormones,” says Dr. Pozuelo. “If a woman is experiencing prevalent feelings of being overwhelmed, stress or irritability, these should be discussed with her physician.”

Research has shown that stress can cause a heart attack, sudden cardiac death, heart failure, or arrhythmias (abnormal heart rhythms), and the new study further defines the importance of the heart’s autonomic system, or the nerve network that regulates heart rate. The research measured heart rate, blood pressure and heart rate variability in 16 women who had chest pain and reduced oxygen to the heart—in the absence of ‘male pattern’ obstructive coronary artery disease—both at rest and when subjected to types of mental stress. Overall, in women with MVD, emotional stress appeared to increase sympathetic nerve stimulation, which is associated with the quickened heart rate of the fight or flight mechanism.

Managing mayhem
While stress and its outcome can seem overwhelming, there are ways to effectively manage it. And, the biggest emphasis should be on exercise, explains Dr. Pozuelo.
Physical activity may seem redundant to women whose lives are typically characterized by multi-tasking as the primary caregiver. But for those who have experienced a cardiac event, the power of exercise should not be overlooked. One way to make certain this important component is added to their daily lives is by participating in cardiac rehabilitation.

A medically directed exercise and lifestyle modification program, cardiac rehabilitation helps patients recover as fully as possible following any type of cardiac event, such as a heart attack, bypass, coronary stenting or valve surgery. The goals of cardiac rehab are to optimize the quality and quantity of a patient’s life by improving their overall heart health, preventing their condition from worsening and helping them make the best lifestyle changes to reduce the risk of future cardiovascular problems.

“It’s been proven that participation in a 12-week cardiac rehabilitation program can lead to a 47 percent reduction in mortality,” says Dr. Pozuelo. “Cardiac rehab is not only helpful physically, but the mental boost is what really pays off in dividends.”

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