Dr Sameer Gupta, one of the country's leading interventional cardiologists talks to CNN News18’s Chaiti Narula about establishing a connection between stress, anxiety, depression and cardiac diseases. In 2013, Dr Gupta was awarded the status of ‘Extraordinary Ability and Achievement’ by the United States government.
How do the biological factors that impact mental health find their way into influencing heart diseases?
Psychological factors and mental illnesses have a bi-directional interaction with heart disease. Not only do underlying mental illnesses significantly increase your risk of heart disease, but patients with heart disease (especially with heart failure or after a heart attack or surgery) are at a significantly higher risk of mental illnesses. We also know that patients who have depression after a heart attack do much worse compared to patients who do not have depression.
What are the stress inducing hormones that eventually impact the normal functioning of the heart?
In a situation of stress there is an activation of the ‘fear and flight’ response in the body. This is the effect of the sympathetic nervous system and is the natural protective response of the body. But this can also have some detrimental effect on your heart. This increases your heart rate, blood pressure, causes endothelial dysfunction (altering the functioning of the lining of the blood vessels) and makes the platelets stickier. Overall, it increases the risk of having arrhythmia's (abnormal heart rhythm), developing blockages, angina and can also lead to an acute heart attack.
Apart from this I’d also like to draw your attention to a condition called the ‘broken heart syndrome’ where the heart muscles suddenly get very weak after an acutely stressful episode. This is not a heart attack and should not be mistaken for one as the blood flow is normal. It is the weakness of the muscle. This transient condition is often precipitated after intense emotional stress caused by grief, loss of a dear one, panic, fear, anxiety and other mental conditions. Apart from these emotional and reasons that cause mental distress; it is also seen after physical stresses like infection, post-surgery, trauma and even with neurological illnesses. Basically any emotional or physical stress on the body can cause severe transient weakness of the muscles of the heart.
What is the real meaning of ‘stress’. This word gets thrown around almost like a frisbee! And what is chronic stress ? How harmful can it be?
Stress can be in any form - personal stressors related to work, family, society to even environmental stressors like an earthquake, floods, blizzards to societal issues like terrorist attacks. In fact, there was an increase in the number of heart attacks and arrythmia's that were reported after 9/11 attacks in New York.
Chronic stress is equally harmful. Whether it is related to work, stress from home, relationships, general stress or anxiety. Chronic stress can increase the risk of heart attacks two to three times. Some research in women have shown that a high level of relationship stress can increase the risk of heart diseases thrice over.
Depression which is usually is a social taboo finally is getting spoken about in whispers in India. We can’t take away from that fact that it is definitely getting increased recognition. How does depression impact the functioning of the heart?
Depression not only increases the risk of heart disease but patients with heart disease have a higher incidence of depression. Depressed patients are more likely to indulge in unhealthy life style like poor food habits, lack of exercise, use of illicit substances and drugs. In depression there are also some physiological changes like platelet function abnormalities making them stickier, abnormal heart rate variability and even alteration in the hormones. All of these factors increase the risk of heart diseases in the patient. Depression can approximately double the risk of heart diseases.
Depression often co-exists with anxiety. According to some studies, anxiety can independently increase the risk of heart disease thrice over.This image is for representation purpose only. (Image courtesy: Getty Images)
What about patients who already have a heart disease? Are they at an increased risk of depression?
It is known that depression is three times more common after a heart attack as a condition in humans in general. In fact 15-20% of patients after a heart attack undergo major depression. Not only heart attacks, patients with heart failure are also at a higher risk of depression. Depression can vary from mild to major when it starts interfering with normal life. Higher the scale of depression, higher the cardiac risk. Because of how common depression is after a heart attack, it is my practice to screen patients for depression, especially after a heart attack and those with heart failure. This is also endorsed by major cardiology societies and is expected to be the standard of care.
What about treating these patients? Are there any special aspects to bear in mind?
It is important to treat depression and other mental illnesses, not just to reduce the risk of heart disease but also for overall well being. Patients are more likely to comply with treatment, follow physician’s advice and adopt a healthier lifestyle if there is a sense of well being. Treating depression in patients with heart disease requires a multi-pronged approach - cognitive behavioral therapy and medications are options. There are some medications like tricyclic anti-depressants and MAO inhibitors that can have significant side effects on the heart and are best avoided. SSRI class of drugs are the usually the treatment of choice to treat depression in cardiac patients, but therapy is individualized to the patient.
Mental stress is just so common in our existing lifestyles. Your tips on coping with them.
Mental stress and anxiety are becoming increasingly more common and recognized nowadays. Once again, a multi-pronged approach with behavioral therapy and medications serves best. However, one should incorporate stress management techniques and exercise into their lifestyle. These therapies are often under utilized. Exercise is not only good for your cardiac well-being but also a great therapy for mental illnesses like depression, anxiety and stress.
Finally, your tips for a healthy heart and a healthy mind that go hand in hand, by your own admission.
Exercise and meditation are reduce the stress hormones, improve mood and overall well being of the person and should be incorporated in one's daily life. They both are effective in keeping the both brain and heart happy and healthy.