A sudden surge of physical activity or a bout of extreme emotional distress can precipitate a heart attack in people who are at risk. Investigators from the University College London, UK, found consistent evidence from previous studies that when normally inactive people engage in a burst of physical activity, or when people are emotionally stressed, angry or excited, they are more likely to experience a heart attack. However, the benefits of exercise outweigh its risks, despite the potential danger associated with bursts of physical activity. Most heart attacks occur when a piece of plaque breaks away from the inside of blood vessels, blocking blood flow to the heart. Vigorous exercise may precipitate this by increasing the chances plaque will become dislodged or by disrupting the normal heart rhythm. Emotional stress may have the same effect on the body, and may also put the heart at risk by increasing blood pressure and releasing stress hormones. To investigate how stress can influence the heart, researchers reviewed studies conducted between 1970 and 2004 that examined what people were doing and feeling in the hours before their heart attacks. Overall, studies found that emotional stress and extreme physical activity were two of the most common triggers reported by heart attack patients. In a study of 224 patients, more than half said they had been very upset or stressed in the 24 hours preceding their attack. In another study, the most common triggers reported by 1818 heart attack patients included heavy physical work, quarrels at work or home, and mental stress. Other studies showed that the risk of heart attack appeared to increase within hours of an earthquake, exciting sports match or high-pressure deadlines at work. Still other research in 1623 heart attack patients found that attacks occurred more often within 2 hours after an angry outburst. The risk of having a heart attack in response to stress appeared to be influenced by how healthy people were to begin with. One study showed that people who rarely exercised were nearly seven times more likely to have a heart attack after vigorous activity than people who exercised regularly. The findings suggest that people who are concerned about heart attack should avoid vigorous exercise in very cold weather, which can place further stress on the heart. People not used to exercise should start gradually, so as not to shock the system. Although it's impossible to avoid all emotional stress, we can learn to control inappropriate emotional displays and keep negative feelings in check.
Psychosomatic Medicine,
March 2005