Stress and Heart Failure
Stress can have a significant impact on heart failure, making symptoms worse over time. Understanding this connection and addressing the stress in your life can help you take more control of your health.
Mass General Brigham cardiologist Mandeep Mehra, MD, MSc, FRCP, executive director of the Center for Advanced Heart Disease at Brigham and Women's Hospital, explains different types of stress and how to get the support you need to protect your heart.
What is the connection between stress and heart failure?
Stress and heart failure are so closely linked that in some cases, stress can even cause heart failure. For people who already live with heart failure, stress can make it worse.
According to Dr. Mehra, three different forms of stress can both contribute to the development of heart failure and worsen it after diagnosis:
Severe (acute) stress happens with a sudden event, such as the death of a loved one (“broken heart syndrome"), a serious accident, or other serious life event.
Post-traumatic stress disorder (PTSD) can cause underlying stress that strains the heart. During times when PTSD resurfaces, heart failure can worsen.
Ongoing (chronic) stress can come from things like relationship problems, financial strain, providing care for a loved one, and health challenges. This stress may not be as severe as acute stress, but it can affect your heart and overall health over time.
How does stress affect heart failure?
Several stress-related factors can affect heart failure. According to Dr. Mehra, these factors fit into two categories:
1. Biological factors
“Stress can promote harmful biological processes in your body that affect your heart,” says Dr. Mehra. These biological factors include:
- Inflammation, which can occur throughout your body and in your heart and blood vessels
- Reduced immunity, which can make you more susceptible to illnesses and further weaken your heart
- Stress hormones such as adrenaline and cortisol can increase blood pressure, heart rate, and inflammation and raise the risk of heart attack and stroke
2. Non-biological factors
Stress can also influence non-biological factors in your daily life by making healthy choices harder and disrupting good habits. Stress may interfere with:
- Exercise
- Healthy eating
- Taking medications consistently
- Self-care
Dr. Mehra says stress affects the heart so greatly that it's part of the evaluation for major heart procedures. "If someone needs something like a heart transplant or an artificial heart pump, an evaluation with a psychologist or psychiatrist for things like stress is part of the process,” he says. “We’re always examining heart patients for stress and helping them start behavioral changes for handling stress better. We believe this is potentially lifesaving.”
Stress management with heart failure
If you’re feeling stressed, Dr. Mehra suggests seeking help immediately. “The cycle of stress and the spiral of worsening stress needs to be broken as quickly as possible,” he says. “The longer it’s allowed to go on, the more it becomes a chronic condition. The last thing we want for people living with heart failure is for stress to progress into another disease that needs to be treated.”
Dr. Mehra encourages sharing your feelings of stress with your providers. "There's no need to hide it or express bravado,” he says. “No one is going to judge you or think you’re weak for asking for help for your stress. We’re going to be glad you brought it up.”
It’s also normal if you don’t know exactly what’s causing your stress. Skilled providers are there to help you figure out why you feel stressed and how to address the causes.
Who can help you with stress
Brigham and Women’s Hospital has a special program called Heart Pal to help people living with heart failure deal with stress and other life challenges. A Heart Pal team includes a doctor, nurse practitioner, and social worker ready to offer support if stress arises in your life. This team is skilled at listening to you, understanding your sources of stress, and offering solutions as part of your overall care plan.
“We’ve found that Heart Pal is one of the most useful things we’ve offered our patients,” says Dr. Mehra.
What if your care team doesn’t offer a program like Heart Pal? If you’re not sure which member of your care team to talk to about stress, Dr. Mehra recommends reaching out to your cardiologist. Your provider has support staff who can assist and make referrals to psychologists and social workers.
Tips for managing stress with heart failure
If you’re experiencing stress, reach out to your providers. While your care team is helping you, you can also do things on your own to manage stress:
- Enjoy a pet: Pets provide companionship, bring comfort, and reduce anxiety and stress.
- Move your body: Do a physical activity you like. Any type of exercise can help reduce stress.
- Socialize: Spend time with other people. Social interaction with people you enjoy reduces feelings of isolation and lowers stress.
Although there are medications for stress, Dr. Mehra suggests trying other methods of stress reduction first, if possible. In his experience, addressing the sources of stress gives better results than medication. Working with your care team to reduce stress will benefit not only your heart but your overall well-being.
Learn about Mass General Brigham Heart and Vascular services
