The disorder can kill you, especially if you are a woman | Health and wellness

Disgust can be deadly. Although rare, cardiologists identify cases of heart attack caused by bad news or a traumatic event, such as a broken heart. This syndrome, called tako-tsubo by the Japanese scientists who discovered it in the 1990s, was initially considered a rare disease but is now known to occur with some frequency throughout the world. It is triggered when a stressful situation releases large amounts of the neurotransmitter catecholamine, similar to adrenaline, which excites the heart and can break one of its valves. This type of cardiovascular disease affects women in 98% of cases. Among them, 2% of heart attacks are caused by an emotional reaction.

Recently, a paper published by the American Heart Association identified a mechanism that may underlie the link between emotional outbursts and heart disease, how unexpected bad news or fear can alter the functioning of blood vessels. At work, a group of young, healthy volunteers were asked to talk for 8 minutes about events that made them angry, worried or sad, while various measures of their cardiovascular health were measured.

Among people who reported experiences that made them angry, the ability of blood vessels to dilate, which serves as a form of cardiovascular protection, was reduced for about 40 minutes, which is associated with an increased likelihood of a heart attack. attack. This did not happen among those who recalled situations that made them anxious or sad.

The authors, led by Daichi Shimbo from Columbia University (USA), suggest that if such effects of negative emotions are repeated, over time, “they may affect the physiology of the cardiovascular system, causing irreversible damage.” The results point in the same direction as other studies, which found that in the hour before a heart attack, a person suffering from a heart attack is more than twice as likely to experience some type of emotional distress as in the same period the previous day. .

“The results provide insight into how stress alters the mechanism that protects arteries from the risk of developing atherosclerotic obstruction,” says Manuel Anguita, a spokesman for the Spanish Society of Cardiology. According to the cardiologist at the Reina Sofía University Hospital in Cordoba, this knowledge could be used to develop pharmacological approaches for people with a high risk profile due to stress. This solution will be added to the psychological approach that helps cope with stress. “We encourage patients to talk to a clinical psychologist to learn how to modulate this stress response. In fact, cardiac rehabilitation units offer not only physical rehabilitation but also psychological rehabilitation,” says Angita, although she notes that this collaboration between cardiologists and psychologists or psychiatrists is “not very developed yet.”

A study published by Shimbo and his collaborators offers an explanation for a phenomenon that has been observed for a long time. Mental illness impairs heart health, and a psychological approach is a very useful tool to prevent these consequences.

“Scientific studies have shown that in patients with untreated chronic depression or chronic anxiety, the risk of cardiovascular diseases such as myocardial infarction, angina, hypertension and stroke increases significantly (by 15–20%),” notes José Luis Carrasco, Director of the Personality Disorders Unit at the San Carlos Clinical Hospital in Madrid. More than the emotional consequences of these ailments, it is because they tend to have an unhealthy diet because they eat anxiously; and they tend to have difficulty controlling their diet, which increases the risk of high cholesterol, diabetes, or metabolic syndrome.

Mental health and cardiovascular risk

In turn, heart problems also increase the risk of mental illness. “It is well known that patients with cardiovascular disease who do not have a history of mental illness have a two to three times greater risk of being diagnosed with a mental illness after diagnosis,” recalls Jorge Pla, a psychiatrist at the University Hospital. de Navarre. “Those who develop mental illness also have a higher risk of death from cardiovascular causes and worse progression to that type of illness if they already have it,” he continues. This increased risk, the specialist explains, suggests that pathophysiological mechanisms may be common, which explains the possibility of developing both diseases. “In the case of depression, it is known that the psychological stress caused by suffering from a serious illness, for example, of cardiovascular origin, and everything that the stress response (hypothalamic-pituitary-adrenal axis) implies can affect a person’s psychological health. a vulnerable patient,” he continues. In addition, in patients with major depression, some inflammatory changes are also detected, which may be present in atherosclerotic or thrombotic processes. “Changes in the vascular endothelium have also been proposed as a common mechanism with forms of depression that begin in old age and have been termed vascular depression,” concludes Pla.

“Patients with cardiovascular disease also often develop depression, especially those who were previously active, because they feel a sense of loss and fear it will happen again. This can lead to a decrease in physical activity and an increase in negative thoughts,” agrees Carrasco, who points out that in such cases it is necessary to intervene, and that for this there are psychiatric departments that are combined with cardiology departments. They evaluate these patients psychologically and treat them, typically with psychotherapy, but “also with anxiolytics or antidepressants, which can lower blood pressure and improve patients’ quality of life,” he says.

Just as there are people who are prone to certain metabolic diseases, some individuals also have a preference for cardiovascular diseases. Very active people, passionate about work, experiencing a high level of internal tension. “This emotional stress can translate into blood pressure, affecting the fibers of the arteries and the endothelial layer of the blood vessels. There are studies that have shown that chronic stress causes high levels of inflammation and oxidation, especially in endothelial cells, which can lead to blood clots and ultimately cardiovascular disease,” explains Carrasco. For these people, techniques for coping with stress, relaxation, or improving interpersonal relationships are effective in reducing risk levels, but because they are so busy, it is difficult for them to devote the necessary time. As in other cases, collaboration between cardiologists and psychiatrists, along with a combination of anxiety-reducing medications and lifestyle changes, can reduce the death rate from heart attacks.

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