An estimated eight million American women have heart disease — a disease that kills more women than all forms of cancer combined, including breast cancer. Dr. Jane-Iris Farhi visited “Weekend Today” to discuss the effects of stress on the heart and broken-heart syndrome.
What is stress? Your definition might be different than mine, but our bodies handle stress in the same way.
Your body responds to stressful stimuli by releasing increased amounts of catecholamines and corticosteroids. They, in turn, increase the heart rate and blood pressure, all in an effort to supply more oxygen to your body. This is usually a good thing. It allows you to deal with stressful events. If you’re being chased by a lion, for example, you need the extra oxygen to be able to run in the other direction. Cathecholamines, which increase the contractions of the heart muscle, have somewhat the same effect as the caffeine in coffee. Drinking half a cup of coffee has been shown to improve mental function. Increasing amounts cause a deterioration, and too much coffee will cause extra heartbeats, increase blood pressure and make you jittery.
It has long been suspected that too much stress and too much hormonal response can actually hurt the heart. Over the past 40 years, drugs that block the body’s response to stress — beta blockers — have been shown to decrease mortality from heart attacks, heart failure and sudden death. Beta blockers thus allow patients with coronary artery disease to exercise longer.
Though it is intuitive that too much stress can be harmful, it is hard to prove. The problem may not be the stress itself, but how we perceive stressful situations — and how we adapt to them. Studies have shown that people asked to speak in public register an increase in their stress hormones, but on repeated performance, the response is blunted. But in 10 percent of those people, the stress hormones actually increase with each appearance.
We’ve all used the expression “scared to death,” but it can actually happen. And stress appears to be a factor.
In a report by medical investigators at Johns Hopkins Hospital, 19 patients who had been in good health, 18 of them women, were hospitalized for heart failure two to three hours after a sudden emotional disturbance. What constituted a “sudden emotional disturbance”? Half of these women had just learned that a relative or close friend had died. Of the others, two had been so surprised by surprise parties that they ended up in the hospital. Another woman had bad stage fright because she had to give a speech. For another woman, according to the chart with the medical journal article, the cause was “armed robbery.” Presumably, she was a bystander.
Their symptoms were chest pain and shortness of breath. Their coronary arteries were normal. Three patients needed a heart-assist device; one had ventricular fibrillation and needed to be resuscitated. Their heart function was 40 percent of normal, and their catecholamine levels were 7 to 35 times normal values. After two weeks of intensive care, their heart muscle function had returned to normal, and remained fine.
When echocardiograms were done at Johns Hopkins, the hearts had an unusual shape. They looked like a water bottle. Think of a balloon that’s filled with water and stretched at the neck. The Japanese, who had previously documented this phenomenon, had a word for it that has caught on in U.S. medical circles: “takotsubo” — the Japanese word for something with a similar shape, the bottle-shaped pot that fishermen use to catch octopuses. (The tentacles fit in the elongated neck, and the body is trapped in the wide base.)
At least four of these patients would have died without medical care, and at autopsy, the pathologists would have reported that their hearts were normal. So stress can literally break your heart.