Every playoff season, I get asked about the impact of stress on the human heart. The joys and heartbreak of watching your team win, then lose, then snatch victory from the jaws of defeat can strain even the stoutest heart. But in the medical field, the impact of stress on the heart is harder to gauge.
There is a real condition called broken heart syndrome, formally called stress induced cardiomyopathy or Takotsubo cardiomyopathy. Though not completely understood, it seems to be caused by the sudden surge of stress hormones after an intense stressful episode.
Importantly, the heart failure seen with Takotsubo cardiomyopathy is not caused by a heart attack. Although the symptoms of chest pain or shortness of breath feel similar, the heart’s arteries are clear when checked after the fact. Treatment and short-term management is the same, minus the blood thinners as there is no blockage.
Most people, vaguely remembering the plot of King Lear from high school, assume that you would die of broken heart syndrome. But the prognosis is surprisingly good. With treatment, heart function returns to normal in most people.
Some fans, like this one at the Bell Centre viewing event, found Game 7 hard to watch. Relax, advises Dr. Christopher Labos. “The millionaires playing professional hockey for your entertainment are going to be fine no matter what happens.” John Kenney / Montreal Gazette
Takotsubo cardiomyopathy is rare relative to heart attacks caused by blocked arteries. Here, the standard risk factors are clear. Age, smoking, high blood pressure, diabetes, cholesterol, sedentary lifestyles and diet drive much of cardiac risk. But not all risk is explainable through these factors, and researchers have tried to evaluate the impact of stress on the development of atherosclerosis.
The issue is hard to study for several reasons. Stress cannot be objectively measured like blood pressure and is inherently subjective and variable. It’s also hard to tease out whether stress directly affects the heart or is just linked to less sleep, more snacking, less exercise and more smoking. It may just be driving unhealthy habits rather than having a direct impact.
The INTERHEART study, a database of tens of thousands of patients across 52 studies, attempted to answer these questions. They asked people to report the presence of work stress, financial stress, home stress and stressful life events in their lives. All four were associated with cardiovascular disease and increased the odds of heart attack by 30 to 50 per cent.
However, put another way, the increase was actually quite modest. The presence of financial stress rose from 12.2 per cent in controls to 14.6 per cent in heart attack patients. The presence of work stress was 5.1 percentage points higher, home stress 3 percentage points higher, and stressful life events 3.1 percentage points higher in heart attack patients than in controls.
But most people want to know if a sudden episode of anger, say from seeing a missed shot on goal, will trigger a heart attack — thus causing you to head to the emergency room and miss the final period of the game.
One study found that the risk of heart attack doubled in the two-hour widow after a burst of angry emotion. While the same caveats about requiring people to self-report their stressful outburst still applies, a doubling of the risk of heart attack over a two-hour period sounds massive. But doubling a small risk still results in a small risk. Of the 1,623 individuals during the study period who had a heart attack, only 39 (or 2.4 per cent) had an outburst of anger in the two hours before.
Despite uncertainty regarding the mechanism of action, the inherent difficulties of measuring stress, and even though its impact is more marginal than something like smoking or diabetes, keeping your cool does matter. So, in the second round of the playoffs, remember to stay calm and care less about the outcome of the game.
The millionaires playing professional hockey for your entertainment are going to be fine no matter what happens. And it’s unlikely that they will come take care of you if you get sick. Viewed that way, getting angry isn’t worth it.
Christopher Labos is a Montreal physician. He’s the host of The Body of Evidence podcast and the author of Does Coffee Cause Cancer?