Stress and emotional health in ischaemic heart disease

When we think about looking after our heart, cholesterol, blood pressure and smoking usually come to mind first. Yet there is another factor we tend to overlook, and it also leaves its mark on the arteries: how we feel. Sustained stress, anxiety, low mood and loneliness all influence how ischaemic heart disease develops and progresses. The good news: they can be worked on too.

First things first: what is ischaemic heart disease?

Ischaemic heart disease occurs when the coronary arteries — the "pipes" that supply blood to the heart muscle itself — become narrowed or blocked, usually by a build-up of cholesterol plaques (atherosclerosis). It can present as angina (chest pain or tightness on exertion) or, in its most serious form, as a heart attack.

What does stress actually do to the heart?

Stress is not just a feeling: it is a physical response. Faced with a threat — real or perceived — the body releases adrenaline and cortisol. That response is useful in a one-off emergency, but when it persists week after week it produces measurable effects:

• Blood pressure and heart rate rise, increasing the heart's workload.
• Inflammation increases, damaging the endothelium — the lining of the arteries.
• Blood clots form more easily, as stress activates platelets and coagulation.
• Habits deteriorate: we sleep worse, eat worse, smoke more and move less.
• Treatment becomes harder to follow: with an overloaded mind, it is easier to miss medication or check-ups.

Large international studies such as INTERHEART place psychosocial factors — stress, depression, adverse life events — among the leading risk factors for heart attack, on a par with hypertension or abdominal obesity.

Acute stress and chronic stress: two different paths

An intense emotional shock can, in susceptible people, trigger takotsubo syndrome — "broken heart syndrome" — a temporary dysfunction of the heart that mimics a heart attack. It is uncommon, but it illustrates just how closely emotion and heart are connected.

Far more common — and more silent — is chronic stress: work or caregiving overload, financial worries, grief or persistent anxiety. In patients who already have ischaemic heart disease, this ongoing state is associated with more angina, poorer quality of life and a higher risk of further events.

Caring for your emotional health is neither a luxury nor an optional extra: in ischaemic heart disease, it is part of the treatment.

Warning signs worth paying attention to

• You notice chest tightness or discomfort at times of emotional strain.
• You regularly sleep badly or wake up exhausted.
• You feel irritable, flat or anxious for most of the day.
• You have dropped your medication, check-ups or exercise because "you can't cope with everything".

If several of these ring true and you have been diagnosed with ischaemic heart disease (or have risk factors), bring it up at your next visit. It is not a weakness: it is valuable clinical information.

What you can do, step by step

1. Move every day

Regular physical exercise — a brisk 30-minute walk most days — is probably the best natural anxiolytic there is, and it directly improves cardiovascular prognosis. If you have had a cardiac event, ask about cardiac rehabilitation programmes.

2. Protect your sleep

Sleeping 7–8 hours, at regular times, helps regulate blood pressure and stress hormones.

3. Train calmness

Slow breathing, muscle relaxation, mindfulness, gentle yoga or simply a walk in nature: pick the tool that suits you and practise it daily, even if only for 10 minutes.

4. Nurture your relationships

Unwanted loneliness is a cardiovascular risk factor in its own right. Supportive relationships — family, friends, groups — protect the heart.

5. Seek professional help if you need it

Psychotherapy (particularly cognitive behavioural therapy) and, where indicated, medical treatment of anxiety or depression improve quality of life and adherence to cardiac treatment. Asking for help is self-care.

Your cardiologist's role

A consultation is not just ECGs and blood tests. Talking about how you are sleeping, your workload or your mood is part of a proper cardiovascular assessment. From there we can fine-tune your treatment, coordinate psychological support when needed, and design a realistic prevention plan that fits your life.

If you have ischaemic heart disease, risk factors, or simply feel that stress is taking its toll, let's talk: your heart listens to how you feel, too.

Sources and further reading

• Yusuf S, et al. The INTERHEART study: effect of risk factors — including psychosocial ones — on myocardial infarction. The Lancet, 2004
• European Society of Cardiology (ESC) clinical practice guidelines
• American Heart Association: warning signs of a heart attack

This article is for information only and does not replace individual assessment or advice from a healthcare professional. For acute symptoms such as severe chest pain, call 112.