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Published on January 30, 2016

stress written on a chalkboard

Stress: The 'other' culprit in heart disease

High blood cholesterol is often the culprit we blame when it comes to our heart attack risk. Yet there’s another key player that has little to do with what we do or don’t eat – stress.

“Stress is a state of emotional tension. It’s not so much the situation that’s causing the stress, but rather how we perceive it,” said Lisa Doom-Anderson, nurse practitioner with North Central Heart Institute at the Avera Heart Hospital. For some people, stress is motivating. For others, it can become a chronic health issue.

Our nervous system was designed to react to dangerous or stressful situations with the “fight or flight” response. “The adrenaline that’s produced is helpful in short, intense situations. But chronically, it can become debilitating,” Doom-Anderson said.

The release of adrenaline increases heart rate, blood pressure and respiration rate, all of which put arteries at greater risk. Also, the inflammatory response that’s involved in many disease processes is a player in heart events, too, and stress can contribute to internal inflammation.

Indirectly, people under stress tend to drink more alcohol, smoke, exercise less or not at all, eat compulsively and in turn gain weight – all of which are risk factors for heart disease.

Stress plays the lead role in takotsubo cardiomyopathy, known as “broken heart syndrome.” Big adrenaline surges in response to a stressful or traumatic event can cause abnormality of the heart’s pumping function. A real heart attack can occur, even when arteries look completely normal on an angiogram. This is most common among post-menopausal women.

The first hurdle in dealing with stress is to recognize that you’re under it, Doom-Anderson said. For many people, an elevated stress mode is normal, and they don’t even recognize that they’re under stress. She recommended a self-test with questions from the American Heart Association.

Do you...

  • Eat food to calm down?
  • Speak and eat very fast?
  • Drink alcohol or smoke?
  • Rush around but don’t get much done?
  • Work too much?
  • Procrastinate?
  • Sleep too little or too much?
  • Try to do too much at once?

If you are constantly under stress, you could be putting yourself at risk for a heart attack, even if you eat a healthy diet. However, if you are leading a stressful lifestyle, chances are, you’re letting things like a healthy diet and exercise slide.

Here’s what you can do

  • Get plenty of sleep.
  • Look on the bright side of life – literally. Learn to speak to yourself with positive messages, such as, “this will be a tough project, but I’ll do the best I can.” Or, “This is a really hard situation, but I know that I can get through it.”
  • Avoid alcohol and tobacco.
  • Exercise. Get 20 to 30 minutes of aerobic activity per day. This will not only relieve your stress, it will strengthen your heart.
  • Do something you enjoy every day – even if it’s just for a few minutes.
  • Try relaxation techniques such as yoga, meditation, visualization or tai chi.
  • Find some “immediate stress stoppers” that work for you:
    • Walk away from stressful situations if it’s not something you need to engage in.
    • Count to 10. Breathe!
    • Sit in a quiet room and concentrate on your breathing for 10 minutes.

Ask your physician about stress and the effects it might have on your body.

For example, untreated high blood pressure over time causes damage to your blood vessels which can increase your risk for heart attack and stroke. “If non-medication efforts aren’t working, you might need treatment to reduce that physiologic response,” Doom-Anderson said.

“Chest pain and shortness of breath are never normal responses to stress. If you experience this or any other symptoms of heart attack, don’t wait. Get help immediately,” she said.

When heart attack strikes, there’s a “golden hour” when treatment is most effective in saving lives. If you or a loved one experience any of these symptoms, call 911 right away:

  • Chest pain or discomfort.
  • Pain or discomfort in the arms, back, neck, jaw, or upper stomach.
  • Shortness of breath.
  • Nausea, lightheadedness, or cold sweats.

To learn more about cardiac care at Avera, go to

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