Can stress give you a heart attack?

 In Cardiology

It has long been known that people in stressful jobs have a higher incidence of heart disease. The famous Whitehall study which started in 1967 took workers in the civil service and studied them over decades. They concluded that there was a higher incidence of heart disease in those who were stressed. This was higher in the jobs that were less well paid, where other risk factors for heart disease such as smoking poor diet and inactivity were more likely. However even when allowances were made for these risk factors, stress was still a significant factor associated with the development of heart disease.

More recently we have recognised a particular type of heart attack that is associated with sudden (acute) stress. Imagine this situation: There is a knock on the door and you open it so see two policeman who ask if they can come in and have a chat. They sit down and break the sad knows that one of your children has died in an accident. You are initially stunned and then develop terrible chest pain, feel lightheaded and breathless. An ambulance is called and the paramedic team suspect you are having a heart attack because of the typical symptoms and the heart tracing (ECG) which shows widespread abnormalities.

A heart attack is normally caused by an artery going to the heart blocking off with clot. However we are increasingly performing coronary angiography (taking pictures of the heart arteries) during a heart attack and find there is no clot or blockage at all in the arteries that go to the heart. Yet blood tests and imaging of the heart confirm there is extensive damage and it is often not working well. This type of heart damage caused by stress is called Takytsubo syndrome or stress related cardiomyopathy. Takysubo is the Japanese term for octopus pot – so called because the first to describe this condition in Japan likened the images of the left ventricle to the shape of the pot. The good news is that this type of heart attack is usually reversible and the heart function frequently recovers completely

Why does this happen? We don’t know but may be due to an overwhelming release of adrenalin which can damage heart muscle cells.

So the simple answer to the question Can stress give you a heart attack is YES!

Featured image of the left ventricle in a patient with Takytsubo syndrome when it is contracting (left) which mimics the shape of the octopus pot (right).

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