Stress: an alarm for the heart

Larissa Melville completed her traineeship in the editorial team of . After studying biology at Ludwig Maximilians University and the Technical University of Munich, she first got to know digital media online at Focus and then decided to learn medical journalism from scratch.

More about the experts All content is checked by medical journalists.

Heavy workloads, worries, fear and stress not only take their toll on the soul, they also damage the heart. In the worst case with fatal consequences: sudden cardiac death.

According to the current German Heart Report, 200,000 people in Germany die each year due to sudden cardiac arrest. Only ten percent of them are cardiac risk patients, i.e. those who have already had a heart attack and suffered from a weak heart muscle or another heart disease. For the remaining 90 percent, death seems to come as a surprise.

Constant stress endangers the heart

Quarrels or acute anger are often the direct triggers. But a closer look reveals that most patients had long before been exposed to stressful situations such as financial worries or problems at work.

"Contrary to popular belief, sudden cardiac death does not usually overtake those affected after a one-off excitement," says psychocardiologist Karl-Heinz Ladwig from the Helmholtz Center in Munich. In most cases, this unpredictable and terrible event is preceded by a lengthy phase of persistent depressive mood. Such people are particularly at risk in an acute stressful situation, explains the expert.

Physiological causes of sudden cardiac death are usually cardiac arrhythmias such as ventricular fibrillation or the so-called Broken Heart Syndrome, in which the coronary arteries become spasmodic.

Disposition and stress

"Even if we do not yet understand all the interrelationships in detail, it turns out that two components are required for stress-related cardiac death," says Ladwig. In addition to physical predisposition, the way people deal with emotional stress also plays an important role. In other words, those who can cope better with stress have a lower risk of sudden cardiac death.

This hypothesis was confirmed in an American study with patients who had survived a heart attack. The directors of the study looked specifically for those affected who had experienced a negative emotional event, such as an argument, shortly before the heart attack, and compared them with a second group of people in whom the heart attack had purely physical causes.

A stress test showed that those at risk of stress reacted very differently to physical stress: their blood pressure and the number of white blood cells, the leukocytes, rose significantly higher."This shows that stress is an independent risk factor for heart disease," says Ladwig, summarizing the results. “This knowledge is of fundamental importance”.

Pay attention to worries

Ladwig argues that doctors should pay more attention to the psychosocial situation of the patient: “Even the targeted addressing of the living situation and psychological well-being can have a high therapeutic value. This is a function that is mostly still underestimated ”.

If real depression is suspected, those affected should see a specialist. Ladwig says: "In most cases, however, more physical activity, targeted stress management or relaxation techniques are sufficient and can significantly reduce the risk of sudden cardiac death".

Source: Press release of the German Society for Cardiology - Heart and Circulatory Research e.V. from April 20, 2017: Stress is an independent risk factor for sudden cardiac death

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