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It turns out that a broken heart may be more than a metaphor.
Sudden emotional stress — from grief, fear, anger or shock — can cause heart failure. The term for this is stress cardiomyopathy. It’s often called “broken heart syndrome,” and it mainly affects women.
Researchers at Johns Hopkins studied patients who had classic heart attack symptoms after a sudden emotional stress but were otherwise generally healthy with no history of heart disease.
The study found that these patients had consistently elevated blood levels of the stress hormones epinephrine, also called adrenaline, and norepinephrine, which appeared to cause a significant weakening of the heart muscle.
Scientists have known for decades that the body pours out adrenaline under stress in the "fight-or-flight" response. This response speeds the heart rate and tenses the muscles to get a person ready to fight or run from a threat. But for some, the rush of adrenaline may be more than the heart can take.
The resulting damage produces symptoms that mimic a typical heart attack, including chest pain, fluid in the lungs and shortness of breath. In fact, broken heart syndrome may be misdiagnosed as a heart attack because the symptoms and test results are similar. But unlike a heart attack, there are no signs of blocked heart arteries.
Instead, part of your heart temporarily enlarges and doesn’t pump well. The rest works as usual or with even more forceful contractions. It can lead to severe, short-term heart muscle failure. But it’s usually treatable, and most people make a full recovery. Why it affects some and not others is not clear.
We know the basic things that are key to protecting the heart. Control blood pressure and cholesterol levels. Manage diabetes. Eat healthy foods and keep a healthy weight. Limit alcohol intake. Don’t smoke.
But other factors affect your heart, too.
In addition to broken heart syndrome, studies show that mental health and cardiovascular health are linked many ways, says the Centers for Disease Control and Prevention.
Some common mental health issues that can affect heart health include:
These mental health disorders can have an indirect effect on heart health by increasing the likelihood of risky behaviors. They can also have a direct physical impact on the heart.
Stress, depression, anxiety and PTSD may cause higher heart rate and blood pressure, reduced blood flow to the heart, and high levels of cortisol. Over time, these effects can lead to calcium buildup in the arteries, metabolic disease and heart disease.
In turn, a cardiac event like a heart attack or stroke can cause mental health issues like depression, anxiety and PTSD.
If you have long-term stress, anxiety, depression or any mental health issue, talk to your doctor or other health care provider. It’s important to seek help for mental health issues and to follow the plan for managing them. Treatment and management of mental health disorders may include a combination of lifestyle changes, counseling and support, and medication.
Life is full of hard, stressful experiences. Chronic stress can weaken your immune system and lead to health problems. And even moderate stress can make other health conditions worse. While you can’t avoid all stress, you can learn to manage it better.
There are steps you can take to head off stress before it overwhelms you. To help protect your health and heart, try these tips from Harvard Medical School:
Originally published February 23, 2015: Revised 2020
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