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Stress and Your Heart Kelleen Fitzgerald, MD March 14, 2015 The Atlanta Internists, LLC
Stress and Your Heart Kelleen Fitzgerald, MD
March 14, 2015
The Atlanta Internists, LLC
What is stress?
Physiological/emotional response to a threat.
STRESS
Acute stress: “Fight or flight” Energy mobilization
Stimulates the Hypothalamic-Pituitary Axis and the Sympathetic Nervous System.
The Atlanta Internists, LLC 2015
• SNS • HPA
Brain
• Vascular function
• Immunity • Coagulation • Glucose
Regulation • Blood pressure • Heart rhythm
Physiologic effects
• Sleep • Relaxation • Positive
emotions • Resilience • Resources
Recovery
• Hypertension • Heart attacks • Stroke • Diabetes • Obesity • Mood-anxiety
disorders • Sleep
disorders • Cancer • Dementia
Disease
Health Behaviors Exercise
Healthy Diet Stress Reduction Habits
Health Behaviors Smoking Poor diet
Sedentary Lifestyle
The Atlanta Internists, LLC 2015
What is Acute stress? STRESS
Acute Anger Interpersonal conflicts Sports matches Traffic
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What is Acute stress? STRESS
Social/Evaluative Threat Performance Rejection Discrimination
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What is Acute stress? STRESS
Acute bereavement Trauma
Assault, abuse Witness to violence
Natural/Environmental disasters Katrina Earthquake
The Atlanta Internists, LLC 2015 Mayo Clinic Proceedings, Vol. 89, Issue 4, p472–477
Twenty-four–hour ambulatory systolic blood pressure (SAP; top line [solid], top panel), mean arterial pressure (MAP; middle line [dashed], top panel), diastolic blood pressure (DAP; bottom
line [solid], top panel), and heart rate (HR; dashed line, middle panel) tracings obtained for subject on March 26 and 27, 1998.
Gianfranco Parati et al. Hypertension. 2001;38:1093-1095
Copyright © American Heart Association, Inc. All rights reserved.
What is Chronic stress? STRESS
Childhood Adversities Occupational Caregiving Burdens
The Atlanta Internists, LLC 2015
What is Chronic stress? STRESS
Socioeconomic Social/Lack of emotional support Marital/Relationship Personality Negative Emotions
The Atlanta Internists, LLC 2015
• SNS • HPA
Brain
• Vascular function
• Immunity • Coagulation • Glucose
Regulation • Blood pressure • Heart rhythm
Physiologic effects
• Sleep • Relaxation • Positive
emotions • Resilience • Resources
Recovery
• Hypertension • Heart attacks • Stroke • Diabetes • Obesity • Mood-anxiety
disorders • Sleep
disorders • Cancer • Dementia
Disease
Health Behaviors Exercise
Healthy Diet Stress Reduction Habits
Health Behaviors Smoking Poor diet
Sedentary Lifestyle
The Atlanta Internists, LLC 2015
stress.org/wp-content/uploads/2011/11/Effects-of-Stress.pdf
stress.org/wp-content/uploads/2011/11/Effects-of-Stress.pdf
stress.org/wp-content/uploads/2011/11/Effects-of-Stress.pdf
stress.org/wp-content/uploads/2011/11/Effects-of-Stress.pdf
stress.org/wp-content/uploads/2011/11/Effects-of-Stress.pdf
stress.org/wp-content/uploads/2011/11/Effects-of-Stress.pdf
Four types of allostatic load.
Bruce S. McEwen Physiol Rev 2007;87:873-904
©2007 by American Physiological Society
Exaggerated reactivity Anger PTSD
Prolonged Response Rumination Worry
Blunted Reactivity Depression Obesity
• SNS • HPA
Brain
• Vascular function
• Immunity • Coagulation • Glucose
Regulation • Blood pressure • Heart rhythm
Physiologic effects
• Sleep • Relaxation • Positive
emotions • Resilience • Resources
Recovery
• Hypertension • Heart attacks • Stroke • Diabetes • Obesity • Mood-anxiety
disorders • Sleep
disorders • Cancer • Dementia
Disease
Health Behaviors Exercise
Healthy Diet Stress Reduction Habits
Health Behaviors Smoking Poor diet
Sedentary Lifestyle
The Atlanta Internists, LLC 2015
Wear and Tear
Apply the Hypothesis
• Hypertension • Stroke • Athersclerosis • Myocardial ischemia
- Induced with physical stress testing
- Psychological stress test
• Increased heart rate • Increased blood pressure • Constriction of blood vessels
SNS stimulation
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Takotsubo Cardiomyopathy An Example
• Triggered by emotional stress • 90% of cases in women • Severe, reversible heart muscle dysfunction • Ballooning of apex of heart on
echocardiogram • High plasma catecholamines (SNS hormones)
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Stress Reduction • Exercise (ideally 3 hours a week) • Daily relaxation
- Yoga/Tai Chi/meditation
• Positive self talk • Find purposeful pleasure
- Hobbies - Social interaction
- Music/nature • Proper Sleep Hygiene
- Avoid electronics before bed.
- Avoid Caffeine and Nicotine
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• Decreased Blood Pressure • Improved Glucose tolerance • Improved Lung function • Decrease in Inflammatory
markers • Decreased Anxiety • Decreased Depression • Reduce Pain sensitivity
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Benefits of Relaxation
