Parkland Medical Center - February 21, 2019

You see it in movies all the time: someone gets upset, clutches their chest and collapses with a heart attack. But can stress really cause a heart attack?

The answer may surprise you.

Not only can stress cause a typical heart attack — also known as myocardial infarction — but stress can also be the culprit behind a heart-attack-like condition called stress or takotsubo cardiomyopathy (TCM), otherwise known as broken heart syndrome.

What is stress, really?

Stress is the body’s response to danger. In early humans, that danger was almost always physical. After hearing the growl of a predator, the sympathetic nervous system would be flooded with hormones, causing the heart to beat faster, rapid breathing and increased oxygen delivery to the brain. This response allowed humans to run faster or fight harder when threatened.

These days you don’t have to worry about hungry smilodons, but your body doesn’t know that. Anything can cause stress. “Stress is a mind phenomenon,” says Thirupathi Reddy, MD, a cardiologist with Regional Medical Center of San Jose. “It’s more of an internal thing for a person, rather than external. External [stressors] are always there to stress you out, but it’s all about how you deal with it.”

Stress and myocardial infarction

A heart attack occurs when the flow of oxygen-rich blood to the heart is blocked, depriving the heart of oxygen and leading to the death of its muscle tissue. The most common reason for a blood flow blockage is a clot, which is often the result of a buildup of plaque in the arteries. When a piece of plaque breaks off from the artery wall (a process called rupturing), blood cells form around it and the clot gets stuck in the artery, blocking blood flow.

When stress is present, your body is flooded with hormones called catecholamines such as adrenaline, says Dr. Reddy. “When you have high levels of catecholamines, the [blood] clotting mechanisms ramp up a bit and the heart beats faster,” he says. “Your heart is working in low gear, trying to handle a lot of load. If there’s some plaque buildup in your coronary arteries, all these together can lead to plaque rupture.”

Broken heart syndrome

There’s another condition cause by stress that has similar symptoms to a heart attack. It’s most commonly called stress cardiomyopathy or takotsubo cardiomyopathy, named after a Japanese octopus pot, shaped like a heart.

“About a third of the time takotsubo cardiomyopathy is provoked by a strong emotion, some horrific circumstance,” says Lyndon Box, MD, an interventional cardiologist with West Valley Medical Center in Caldwell, Idaho. “After this event the person experiences the same symptoms of a heart attack, the same chest pain, difficulty breathing, nausea.”

Even some of the diagnostic tests, like the electrocardiogram, will look the same as a heart attack, but an angiogram will show no blockage in the arteries. Although the arteries are normal, the heart function is weakened and portions of the heart are not contracting the way they should, Dr. Box says. Doctors aren’t sure why, but the theory is that a stress signal from the brain damages either the heart or the arteries.

“Stress cardiomyopathies are much rarer than a heart attack and women between the ages of 50 to 70 are the most common patients,” Box says, “so it’s unlikely that a person will die from broken heart syndrome and most people make a full recovery with the aid of beta-blockers and ACE inhibitors.”

Learning how to manage your stress and anxiety levels is crucial to your heart’s health. Talk with your doctor if you are dealing with intense stress at work or at home.

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