If you guessed "mental stress," you are right. While exercise stress tests on the treadmill can provoke transient heart symptoms, mental stress is much more demanding...and even debilitating...over the long run. And the two together can be devastating.

I recall a study some years ago where researchers evaluated 126 volunteer patients (112 men and 14 women) with a history of coronary artery disease. In a laboratory setting, the volunteers underwent a series of psychological stress tests including mental arithmetic, during which they were asked to perform a series of additions and calculations. Then they were asked to do public speaking, reading and a structured interview designed to provoke aggressiveness and irritation. After a 20-minute rest period, the subjects performed an exercise stress test on a bicycle.

Cardiovascular responses to the mental and physical stress tests were evaluated using sophisticated nuclear radiology techniques that measured motion abnormalities in the heart's left ventricle. During a two-to-five-year followup, 28 patients had at least one cardiac event ranging from new heart attacks, bypass surgery and angioplasty. Two patients suffered fatal cardiac events.

The researchers found that patients who had overreacted to mental stress had nearly three times the relative risk of having a cardiac event or dying compared to patients who did not exhibit cardiac vulnerability from mental stress. The findings also confirmed that exercise-induced diminution of cardiac blood flow was not as strong a predictor of subsequent cardiac events as poor response to mental stress. This suggests that mental stress is a much more accurate predictor of cardiac events than traditional exercise stress testing. This particular study strengthened my belief in the role that psychological stress plays in cardiac events--and which I was seeing on a pretty regular basis in my practice.

Some years ago, I gave a talk to the American Heart Association on stress and cardiovascular disease. One of the local chapter officers came up to me afterwards and said, "I really appreciated your lecture. Nothing provokes my angina like getting into a verbal confrontation with my 16-year-old son."

We typically associate only unpleasant or undesirable events (such as being layed off or losing a spouse) with stress, but happy or joyous events (such as the arrival of a new child or getting a promotion) can also be quite stressful.

Properly handled, neither type of stress usually escalates into a physical problem. But unhealthy responses to stress, or a prolonged stress reaction, like driving too fast, drinking, overworking, overeating and suppressing anger or grief,can stoke serious health consequences.

I have often used emotional healing techniques and short-term therapy sessions for cardiac patients. The goal is to help achieve relief from anxiety, obsession, depression, and unresolved feelings. Talking over a problem with someone you trust can help you find a satisfactory solution to distinguish between things that are "worth fighting for" from those that are less important.

Getting feedback and support from others, such as in group psychotherapy situations or with a private therapist, it is possible to gain new insights into yourself that can also put you on the road to physical healing or prevent trouble down the road. Mind/body medicine works wonders!

About the Author

Stephen Sinatra

Stephen T. Sinatra, M.D., F.A.C.C., specializes in metabolic cardiology and is the author of the monthly newsletter Heart, Health & Nutrition.

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