Stress is a feeling of physical or emotional tension and is often a response to change. It is part of everyday life, and individuals reacts to stress in their own way.
Significant emotional stress can cause a specific “fight or flight” response from the body. As part of this response, energy is taken from the immune system, digestive system and other body systems and used to prepare the body for dealing with a threat by speeding up the heart rate, raising blood pressure and metabolic rate.
People can experience either temporary, intense periods of stress (acute stress) or longer, “nagging” periods of stress (chronic stress). The body is designed to deal with acute stress and then return to normal. It is not designed to deal with chronic stress, such as dreading going to work every single day. Overwhelming the body’s natural defenses, chronic stress can increase the risk of a variety of heart-related conditions such as high blood pressure (hypertension), or cardiac events such as heart attack or stroke. Frequent or lasting periods of significant emotional stress have also been associated with an increased risk of abnormal heart rhythms (arrhythmias) and higher levels of cholesterol.
Heart patients are especially encouraged to learn stress management techniques. Stress management refers to a strategy of controlling stress and reducing its impact. Adopting appropriate coping mechanisms can relieve stress in a healthy, productive way. The American Heart Association emphasizes that outside events are less important than how individuals react to them. Studies show that heart patients can reduce their risk of a cardiac event by up to 75 percent by using healthy stress management techniques, including learning to:
Relax in a healthy way. Healthy strategies include relaxation, meditation or breathing exercises. Unhealthy strategies include excessive alcohol use, drug use (e.g., smoking cigarettes or marijuana) and verbal/physical abuse.
Identify the problem. Many people are often not aware of the reason for their feeling tense or stressed. Identifying the problem is essential to keep it from happening over and over again in the future.
Address the problem. Sometimes addressing a problem means making a change, and sometimes it means accepting the situation as out of one’s control without stressing about it any further.
With practice, these stress management techniques help people to gain control over stress, instead of allowing stress to gain control over them. Most physicians are reluctant to prescribe medications to treat stress (unless the person has been diagnosed with an anxiety disorder), because many of these medications tend to be addictive. Therefore, people are urged to take the time to learn and practice healthy stress management strategies to improve their physical and emotional health.
Stress management includes all aspects of your life: physical, emotional and behavioral well-being, nutrition, exercise, the amount and quality of sleep you get, leisure activities, coping skills, communication skills, relationship management and so on. More and more research is showing that stress management can help prevent heart disease and help heart patients recover.
Stress management also includes changing the perception of stress. A large amount of the stress people encounter is self-generated; that is, the way individuals perceive or think about a situation or event affects how much stress they feel.
About stress
Stress is a person’s physical and emotional response to change. While most people tend to think of stress as bad, it can be either positive or negative. Sources of positive stress include having a new baby or starting an exciting new job. Sources of negative stress include divorce, unemployment or legal battles. It may take only a short time to adjust to the change (acutestress) or it may take a much longer time (chronicstress).
Acute stress is an immediate reaction to a change that is judged as threatening (stressor). Sources of acute stress include a car suddenly cutting someone off in traffic, or hearing a loud, unexpected noise. Not only does the threat tend to create feelings such as fear or nervousness in the person, but the threat also can set off the body’s alarm system, triggering a “fight or flight” response. This response prepares the body to either fight or flee from a perceived threat to it, after which the body returns to normal.
If all stressors were acute, then stress would not be such a critical issue in modern society. People would simply respond to an immediate threat, and then their body’s systems would return to normal. Unfortunately, there are many changes in modern society to which it is more difficult to respond, such as daily job stress, unrelenting financial pressures and dysfunctional long-term relationships. The longer that people go without either changing or adapting to these changes, the longer they will experience stress. The type of stress that people experience for a long period of time is called chronic stress.
Because chronic stress results from changes that are not addressed, this lack of action leaves the body in a state of heightened awareness or tension. Sooner or later the energy drain on the system will cause the body to fall behind in the self-repair and maintenance necessary for good health. The unrelenting wear and tear of changes brought about by stress hormones can lead to conditions such as ulcers, heartburn, diarrhea, tension headaches, and muscles spasms or aching in the jaw, neck, back and shoulders. Chronic stress has also been associated with the following:
Cardiovascular events such as heart attack or stroke
Suppressed immune system resulting in more upper respiratory infections and other infectious diseases
Slowed wound-healing
Herpes outbreaks
Irritable bowel syndrome (IBS) attacks
Decreased sex drive
Asthma attacks
Angina attacks
Colitis attacks
Symptom flare-ups of multiple sclerosis (MS)
Blood pressure elevations
Increased chronic pain
Arthritis flare-ups
Poor control of diabetes
Stress may also hinder the recovery of heart patients following a first heart attack, as well as lead to future heart problems.
Furthermore, chronic stress takes an emotional toll because the feelings of fear or nervousness remain constant without relief. Consequently, chronic stress can be both physically and emotionally harmful. Because of the many physical dangers of stress, stress management has been proposed as a vital component in the treatment of conditions ranging from heart disease to diabetes. Some studies have even shown its usefulness in the treatment of cancer.
Effects of stress on the body
Stress is a biological response to a perceived threat. The threat may be physical, as in a near-miss car accident, or it may be emotional or mental, such as job or relationship stress. No matter what kind of stress is involved, however, the body's reaction is similar. This stress response is also known at the “fight or flight” response.
In situations of physical danger, the person’s sensory receptors (e.g., eyes and ears) detect the change and send messages to the brain via somatosensory fibers. This message basically says, “Something’s out there; what do you think of it?” The limbic system, the part of the brain associated with emotion, may send out a “red alert” message if it perceives a threat.
The part of the brain that responds to the emergency call is the hypothalamus, which is responsible for a wide variety of functions from sleeping and waking to sexual response. The hypothalamus sends out the warning to the rest of the body by doing four things very quickly. First, it sends a message directly to the adrenal glands, which are located on top of the kidneys, to release two hormones, epinephrine (adrenaline) and norepinephrine (noradrenaline). These two hormones race through the bloodstream to speed up the body’s organs in preparing for fight or flight. For example, the rate and force of the heartbeat will increase significantly.
Second, the hypothalamus releases a chemical called corticotrophin releasing factor (CRF). The CRF carries the warning message to the nearby pituitary gland, which responds by releasing adrenocorticotropic hormone (ACTH). The ACTH travels quickly to the adrenal glands, which receive the message and release a variety of chemicals in response, especially cortisol and aldosterone. Cortisol is responsible for supplying the body with necessary energy for the situation, which it does in a variety of ways; for example, it stimulates the liver’s release of cholesterol, fats, protein and glucose, and it takes energy from the immune system, thus temporarily shutting the immune system down. Aldosterone is responsible for increasing blood pressure for maximum readiness, which it does by helping the body retain sodium (and, therefore, water) in the blood.
Third, the hypothalamus stimulates the pituitary gland to release another two hormones: oxytocin and vasopressin (antidiuretic hormone; ADH). These hormones are responsible for keeping the blood pressure elevated, so that the heart, muscles and brain can get the oxygen needed for optimal functioning in the face of danger. Saliva may dry up in the mouth as fluids are transferred to more essential areas, such as the brain and muscles. The blood’s clotting ability is also increased, so that the body will lose less blood/fluids in the event of an injury.
Finally, the hypothalamus releases thyrotropic releasing hormone (TRH), which stimulates the pituitary gland to release thyrotropic stimulating hormone (TSH). As this hormone travels through the bloodstream, it stimulates the thyroid gland (located in the neck) to produce two chemicals: thyroxine and triiodothyronine. These two chemicals are responsible for speeding up the body’s metabolism, resulting in the acceleration of the following processes: blood pressure, breathing, heart rate, thinking processes and perspiration. The liver produces sugar from its stores of glycogen (composed of excess sugars, proteins and fat) and releases it into the bloodstream to provide extra energy for the body.
In situations of lasting emotional or mental stress, parts of this system may be activated on a more or less constant basis (chronic stress). The semi-permanent presence of stress chemicals in the body raises the risk of heart disease and other medical conditions. If this stress response is activated by a single event, it is known as acute stress. Many studies have shown that acute stress is linked to heart attack.
Symptoms of stress
Symptoms of stress can be either behavioral or physical. Behavioral symptoms include the following:
Too much sleep (hypersomnia) or too little sleep (insomnia)
Nightmares
Nervous habits like nail-biting or foot-tapping
Decreased sex drive
Teeth grinding
Irritability or impatience
Crying over minor incidents
Dreading going to work or other activities
Physical symptoms include the following:
Migraine or tension headaches
Digestive problems (e.g., heartburn, diarrhea)
Shallow breathing or sighing
Cold or sweaty palms
Muscular tension and aches in the jaw, neck, back or shoulders
Effects of stress on heart health
The “fight or flight” response involves a complex series of reactions between mind and body. This is a normal and essential process, to a point. For our ancestors, the stressors were largely physical, such as the daily challenge to survive. The relatively brief surges in the body’s metabolism were necessary to hunt, fight, evade a predator or seek shelter.
In contrast, modern stressors are typically emotional, be they positive (preparing for big event) or negative (e.g., bereavement, divorce, financial insecurities). As such, they tend to be chronic, causing a continued stress response that can impact on cardiovascular health either directly or indirectly.
The stress response includes a number of physical changes that can affect cardiovascular health, including:
A faster heartbeat can make the person vulnerable to certain types of chest pain(angina) and abnormal heart rhythms (arrhythmias).
Stickier or thicker blood due to greater clotting ability can raise the risk of blood clots.
Cardiac ischemia (a condition in which the heart does not get enough blood) is sometimes seen in response to stress, because stress causes the blood vessels to constrict abruptly. This decreases the blood flow to the heart, which over time can significantly increase the risk of death from a cardiovascular event.
Glucose and fatty acids are converted to cholesterol if not used as energy during the stress response. This can promote hardening of the arteries (atherosclerosis). The process of atherosclerosis may also be hastened by frequent increases in blood pressure, which can thicken the walls of the blood vessels. As a result, stress has been linked with an increased risk of heart attack and stroke.
The sustained presence of stress hormones keeps the body in a state of tension, which can weaken the cardiovascular system over time and increase the likelihood of developing high blood pressure (hypertension).
In addition, chronic stress has been linked to a condition called insulin resistance syndrome. This syndrome is characterized by an inability to convert food into usable energy and, consequently, seems to interfere with the body’s ability to dissolve blood clots. As a result, the body is more at risk for heart disease and other cardiovascular conditions.
People with driven or overcommitted personalities may have chronic stress and, therefore, may be at greater risk. Over time, this chronic stress may come to feel “normal” to some people, but the body is under stress all the same.
Researchers have recently discovered that some people can experience stress without realizing it. Participants in a study took a mental test designed to increase their stress level. Some of the participants did not report feeling stressed, and their pulse level remained the same. However, their blood pressure increased significantly, and researchers found they had a six-fold increase in the risk of heart attack or other severe coronary event.
Managing stress
Managing stress begins with identifying the stressor(s). A stressor is the cause of our stress, and it can be both good and bad. For example, starting a new job is usually a positive experience – and one that often causes stress while settling into new responsibilities.
In this example, the stressor is obvious. At other times, individuals may feel stressed without knowing why. The better people understand the stressors that affect them, the more effective they will be in controlling them.
It may be helpful to keep a daily log of activities and jot down the events that trigger stress reactions. After a week, examine the log for any patterns. If no pattern to stress is apparent, counseling may help identify the hidden stressors in one's life.
A person can use the following questions as a guide to finding a pattern to stress:
What major changes have occurred in my life recently? These include illness, moving, changing jobs, unemployment, beginning or ending a relationship and life cycle transitions (marriage, pregnancy and raising children, loss of a loved one).
Are there time pressures? Poor time management, in professional and personal lives, is a major cause of stress. Often, people sacrifice personal time to fulfill obligations to family and work. Sooner or later, the imbalance in our lives will catch up and cause feelings of pressure and stress.
How intense is the stress? The frequency, intensity and duration of our stress may indicate its severity and cause. If stress levels skyrocket during work and drops when going home, the cause is obvious. If there is a nagging anxiety all the time, the stress may have a more subtle cause.
Is lifestyle affecting the ability to handle stress? Many people use alcohol or drugs to relieve stress, but they may in fact be a cause of stress. Lack of sleep is another cause of stress. Sleep helps our bodies to recover from the day’s events and challenges. Staying up late or frequent interruptions interferes with the ability to cope with stress. Lack of exercise may contribute to stress as well. Exercise has been shown to decrease the amount of stress hormones that are released in response to stress.
Are eating habits a factor in stress? A balanced diet high in vitamin C and low in caffeine and sugar can help reduce stress. Conversely, a poor diet and erratic eating schedule can put the body under physical stress, making it harder for someone to deal with stressful situations.
Is physical health a factor in stress? Pain and discomfort are both stressors. Illness and injury put the body under physical stress, which is a cause for emotional stress. Emotional stress, incidentally, is often perceived as a physical discomfort, such as stomach cramps.
How is stress being dealt with? The wrong coping mechanism may be ineffective or even contribute to stress. Negative coping methods to avoid include:
Criticizing one's self or blaming others
Yelling
Eating too much or too little
Smoking cigarettes
Abusing alcohol or drugs
Being isolated from friends and family
Acting aggressively or violently
Focusing on other people’s problems
Avoiding one's own problems
Healthy coping strategies
Healthy coping strategies include relaxation, physical exercise, communication and social support. To manage stress effectively, a combination is a good strategy.
Relaxation
Relaxation includes taking a walk, listening to music or an inspirational tape or talking with a friend or family member.
People can practice specific activities designed to relax the body and mind. These activities include:
Relaxation exercises. These activities focus on relaxing the body, with the idea that the mind cannot be at peace while the body is tense. People tend to hold tension in certain parts of the body without even realizing it. These activities release that tension, contributing to peace of mind.
Meditation exercises. These activities set the mind on a journey while the body remains still. Still meditation can be performed almost anywhere to relieve excessive stress, such as while waiting to see a doctor, in the morning to start the day in a positive frame of mind, to put a problem into perspective and many other situations.
Breathing exercises. These activities create a physical change in the body through controlled breathing. When under stress, people's breathing patterns change, creating a physical response to their emotional stress. Breathing activities can help restore a sense of calm and control.
Visualization. These activities combine aspects of meditation and relaxation to place the body and mind at rest. Visualization correctly uses all the senses as it focuses on a particular object or situation.
Physical activity
Regular physical exercise has been shown to decrease the level of stress hormones the body releases in response to stress. Exercise has been touted as the single most effective technique to relieve stress. Individuals, especially those with heart conditions, should consult a physician before beginning an exercise program.
Aerobic exercise is especially helpful in reducing stress. Experts recommend performing about 20 minutes of aerobic exercise three times a week.
Stretching is a form of exercise that relieves muscle tension.
A brisk walk is a healthy way to clear the mind and relieve tension. Research indicated that a brisk 10-minute walk every day protects against vulnerability to stress-related disease.
Communication and social support
Healthy communication, such as the ability to confide to a friend can be a great stress reliever. A healthy social network is a major factor in managing stress. This is the support provided by family, friends and the community in general (religious or social organizations, etc.). Individuals with heart disease, stroke and other illnesses can take advantage of support groups. People under stress should not hesitate to reach out.
In addition to social support, there is self-communication. This may take the form of a stress journal (mentioned above) or a diary. Writing letters can be a highly effective method in managing stress – except these letters are never meant to be sent or even read by anyone other than the writer.
This strategy has been used by many great leaders, who often operate under conflicting and never–ending pressures, to relieve stress. It is advisable to write these letters on paper and not electronically, as they could accidentally be sent over e-mail or read by the wrong person.
People feeling overwhelmed by stress and unable to cope may want to seek professional counseling. Professional counselors include psychiatrists, psychologists, licensed social workers, marriage and family therapists and mental health counselors.
A mental health professional can teach a person how to perceive stress and develop appropriate coping skills and problem-solving skills. Muscle relaxation techniques, time-management and other skills may be taught.
Questions for your doctor regarding stress
Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about stress:
How can I tell if I have too much stress?
What are some of the likely causes of my stress?
Can stress management help me cope with a heart condition?
Can it help prevent illness?
Am I physically fit for stress management techniques such as exercise?
Do you recommend cardiac support groups or counseling?
What are some signs that I might be a candidate for professional counseling?
Are there any medications that might be able to reduce my stress level?
Are there any lifestyle changes I can make that might help my stress levels to improve?
How can I identify the parts of my life that are causing the greatest levels of stress?
Could my pregnancy be causing greater than normal stress?
