Stress and Your Heart Kelleen Fitzgerald, MD

March 14, 2015

The Atlanta Internists, LLC

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.

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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

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What is Acute stress? STRESS

Acute Anger Interpersonal conflicts Sports matches Traffic

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What is Acute stress? STRESS

Social/Evaluative Threat Performance Rejection Discrimination

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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

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.

What is Chronic stress? STRESS

Childhood Adversities Occupational Caregiving Burdens

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What is Chronic stress? STRESS

Socioeconomic Social/Lack of emotional support Marital/Relationship Personality Negative Emotions

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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

stress.org/wp-content/uploads/2011/11/Effects-of-Stress.pdf

stress.org/wp-content/uploads/2011/11/Effects-of-Stress.pdf

stress.org/wp-content/uploads/2011/11/Effects-of-Stress.pdf

stress.org/wp-content/uploads/2011/11/Effects-of-Stress.pdf

stress.org/wp-content/uploads/2011/11/Effects-of-Stress.pdf

stress.org/wp-content/uploads/2011/11/Effects-of-Stress.pdf

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

• 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

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

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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

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Benefits of Relaxation