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Early  in my career, I cared for a man in his middle 50’s who experienced a major heart attack. I was surprised to find out that he had very low cholesterol and normal blood pressure. He did not smoke. Therefore he did not have any of the major traditional cardiac risk factors.  

To find out what caused his heart attack, I probed deeper and found out he recently had experienced major psychological stress related to a business he owned that was failing. This, I believe, was the major risk factor that triggered his heart attack.  

Over the years, I have become familiar with a large body of medical research that confirms the link between psychological stress and heart disease. Research shows that psychological factors can contribute to heart disease by causing damage to the inner lining of the coronary arteries. People who have trouble controlling their anger or who are experiencing significant depression are particularly susceptible to this type of blood vessel damage.  

When one is under psychological stress, there is often the compulsion to eat more unhealthy foods, eat more sugar or smoke more cigarettes, all of which can also contribute to blood vessel injury. This blood vessel damage can be caused by increased levels of inflammation and stress hormones (cortisol and adrenaline) that can occur in association with psychological stress.

There is a more fundamental connection between the mind and the heart. Many of us have heard of the term “fight or flight response,” which was a term coined by Dr. Walter Cannon in 1915 to describe the human body’s reaction to facing a dangerous situation which is acutely stressful. When we are confronted by a threat, our brain activates the sympathetic nervous system via nerve fibers that originate in certain parts of our brain and connect to the heart. 

This activation of the nervous system results in the release of stress hormones, which can cause our blood pressure to elevate and our heart rate to rise. Cannon used a term, “voodoo death,” to describe people who literally became “scared to death,” when faced with a very threatening situation, which caused a strong emotional reaction. 

In those cases, research has shown the brain can release an overwhelming amount of chemicals into our hearts. This “overdose” of brain chemicals can cause heart attacks and other forms of heart damage. This is an example of the mind-body connection, which challenges the old notion that the mind and body are separate and unconnected entities.

On a positive note, individuals who have a more optimistic outlook on life are less likely to experience angina, heart attack or sudden cardiac death.

So what can we do to take care of our heart and mind health? We can try to reduce risk factors by making modifications to our lifestyles such as healthier eating, meditation, exercise, prayer and/or increased socialization with others. As always, when a situation like psychological stress or depression becomes overwhelming, contact your doctor for more guidance on what can be done to help.

Dr. Mark Roth writes about internal medicine for the Cleveland Jewish News. He is an internal medicine physician with University Hospitals.  

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