“*Teck Leong, 33, has been feeling dizzy and has frequent heart palpitations. At work, he is under immense stress to hit his sales target and has been smoking a pack of cigarettes a day, eating unhealthily and staying out late to entertain his clients. He fainted one day and was admitted to the hospital. It was found that he had suffered a stroke”
In cases like Teck Leong’s, many people will be quick to say, “It must’ve been the stress that caused the stroke” but is this statement really true? Sunway Medical Centre’s Cardiologist, Dr. Teoh Jun Kiat, shines a light on the real connection between stress and the heart.
Urban Health: What is the relationship between stress and heart disease?
Dr. Teoh Jun Kiat: Stress by itself does not directly lead to heart disease. It is how the individual copes with stress that is the key determining factor. If he or she decides to smoke cigarettes, overeat or drink alcohol in excess as a way to deal with stress, then this will increase that individual’s risk of developing coronary artery disease which is the narrowing of the heart arteries. Conversely, some people address their high stress levels by exercising. This would have a beneficial effect on the person’s cardiovascular health.
Urban Health: Who is at high risk of stress-related heart problems?
Dr. Teoh: Stress can affect any individual because it is subjective. Almost everyone has experienced some level of stress. Some individuals have excellent coping mechanisms that allow them to cope with stressful jobs or situations with ease. The Centers for Disease Control (CDC) in the US found that among workers younger than 55 years old, blue collar employees have a higher prevalence of heart disease. It is too simplistic to blame any particular occupational group for the high rates of heart disease because coronary heart disease develops due to an interaction of multiple genetic, lifestyle and health factors.
UH: What are some ways to determine whether a person’s heart problems may be caused by stress?
Dr. Teoh: There is no test to determine whether a person’s heart condition is linked to stress. Heart disease develops due to the interplay of multiple physical, psychological and social factors.
UH: What are the short term and long-term effects of stress on the heart and the body, in general?
Dr. Teoh: Acute stress or short-term stress can cause a person to experience symptoms such as palpitations (a pounding and fast heart beat), fast breathing or hyperventilation, headache, back ache, sweating and/or a ‘tummy upset’. If stress is prolonged over a period of time, it can affect the whole body and issues such as a depressed immune system, elevated blood pressure and the over secretion of gastric acid which may lead to peptic ulcer disease.
UH: How can heart problems brought on by stress, be treated?
Dr. Teoh: Heart problems are treated based on clinical evidence. For example, severe narrowing in the coronary arteries which causes symptoms can be treated by medicine, stents or bypass surgery depending on the clinical circumstances. If stress has a major effect on a heart patient’s mental health, then this patient should be referred to a clinical psychologist for suitable psychological interventions. Stress management is important as poor coping strategies often lead to high-risk behaviour such as smoking and excessive alcohol consumption.
UH: What role does diet and exercise play in helping stress-related heart problems?
Dr. Teoh: Exercise is a powerful tool to combat stress but unfortunately it is under-utilised. It increases the brain’s production of endorphins which are hormones that make us feel good about ourselves. Additionally, it also distracts our mind from over focusing on the stresses of our jobs and improves sleep which is often disrupted by stress and anxiety. In terms of diet, consume fatty fish such as salmon and tuna, oatmeal, leafy vegetables, almond and dark chocolate in moderation. Exercise and a carefully selected diet can go a long way to making one feel better about oneself.
UH: What about Takotsubo cardiomyopathy? How does this differ from the other types of heart problems?
Dr. Teoh: Stress cardiomyopathy, also known as Takotsubo cardiomyopathy (cardiomyopathy means disease of the heart muscle) was first reported in Japan. The majority of patients diagnosed with this condition experienced sudden and significant emotional stress prior to becoming unwell. Often this emotional stress could be due to a sudden bereavement or being involved in a major disaster such as an earthquake. Hence, this condition is also sometimes known as the ‘broken heart syndrome’. The major difference between Takotsubo cardiomyopathy and other heart diseases is that the former is self-limiting, reversible and highly unlikely to occur again.
UH: What is your advice to patients who may be under a lot of stress and at high risk of contracting heart disease?
Dr. Teoh: My advice is to always maintain rational and sensible thinking when faced with what is perceived to be a stressful situation or job. We are sometimes prone to ‘catastrophise’. Don’t do it. Break down the stressful circumstance into smaller components and tackle each part, one by one. Do not be afraid to seek advice and help. Never feel that you are alone. Discuss with others — a problem shared is a problem halved. Make sure you allocate time to de-stress and exercise is a great way to do just that. Go for a 30-minute run and empty your mind. You will often find that your mind and body are refreshed after a physical work-out.
Do not succumb to cigarette smoking or excessive drinking as it does infinitely more harm than good. Maintain good family and social ties to allow you to share your joys as well as your worries. Last but not least, always be optimistic that in the end everything (or at least most things) will turn out fine.