Scott Webb (Host): Most of us know that stress affects us emotionally, but stress can affect us physically as well, especially our hearts. And today, Meera Mohan is here. She's a Nurse Practitioner specializing in Cardiac Care at Franciscan Health, and she's going to explain how stress affects our hearts and what we can do to help ease the physical and emotional toll that stress places on all of us.

 This is the Franciscan Health Doc Pod. I'm Scott Webb.

Meera it's so nice to have you here today. We're going to talk about heart and stress and how the two things go together and how we might be able to recognize the signs and symptoms and what we can do about stress and its affect on our hearts and all that good stuff. So maybe you could just share some background on how stress, which of course we all have in our lives to some degree, affects us physically as well as emotionally.

Meera Mohan, DNP: That's a great question. That's a great place to start when talking about how stress affects our heart. Stress is actually our response to a given situation. So we become stressed when we feel that the situation places demand on us that are beyond our ability to manage.

So when this happens, we can feel emotions such as fear, distress, anger, grief, avoidance, and as a result, a few things happen in our body. The first is there are parts of our brain that process our emotional response, and as a result, that activates the sympathetic nervous system. This is the part of our nervous system that causes the quote unquote fight or flight response. And as a result, our heart rate and blood pressure can go up. Our blood vessels can constrict or tighten.

The second thing that can happen is the brain also releases hormones, which cause an increase in the hormone called cortisol. And this can affect our blood pressure as well. It can cause insulin resistance, which is how our body processes glucose or sugar in our body. And it can also cause fat to be deposited centrally in our abdomen.

And then the last way that stress can affect us biologically is that it can affect our immune system. And this causes a state of inflammation that can lead to more cholesterol being deposited in our arteries. So when all of these downstream effects occur, this increases our risk for cardiovascular disease.

Host: Right.

Meera Mohan, DNP: And you mentioned that stress affects us emotionally. Well, stress can also lead to mental health conditions such as post-traumatic stress disorder, depression, and anxiety.

Host: Right. Yeah. It's a lot to take in and I think I'm, right here with you. It's so true. And I think all of us as humans who've experienced, you know, stress in our lives or stressors in our lives, we've suffered a little bit emotionally, physically, all the above. What are some of the common symptoms that we might experience if we're under a lot of stress?

Meera Mohan, DNP: Sure, because our body releases hormones and our nervous system is being activated, we can experience symptoms like chest pain or body pains, palpitations, which is the feeling of our heart beating fast or skipping a beat. We can also experience headaches, dizziness, fatigue, tiredness. We can have difficulty sleeping. So there's a range of symptoms that stress can cause.

Host: Yeah. I'm wondering is there a, like a test, you know, for stress? I, I'm sure a lot of us have taken a quiz, you know, where we're asked about life experiences or stressors to maybe see where we fall on a stress scale. But are there ways to determine if our stress could be kind of making us sick in a way?

Meera Mohan, DNP: Yeah, you know, there are a lot of self-assessments, that are available online. A simple online search can result in many different types of self-assessments that people can choose to take. A common self-assessment that is used is the Perceived Stress Scale. And this can also be found online.

This is a 10 question questionnaire. A 10 question assessment that evaluates the severity of stress we have in our lives. Another good questionnaire is one that can evaluate the level of depression, anxiety, or stress that we have in our lives. And that's called DAS 21 or Depression, Anxiety, Stress scale.

Host: Okay.

Meera Mohan, DNP: But actually a good way to see if stress is actually making us sick, is to keep a journal. So in a journal, people can write down what they find stressful, their emotional reaction to the situation, and what physical symptoms they experience as a result. They can also keep a record of when they have these symptoms and identify their thoughts and situations they're in when the symptoms occur.

So that's a good way to correlate symptoms with a stressful situation. But sometimes though it's hard to tell if the symptoms that we're having is due to stress and that's okay. Stress can be chronic and constant, it can kind of linger in the background all the time. And we can have symptoms like chest pain and palpitations as a result.

So when we do have those kinds of symptoms, I would recommend seeing a doctor to rule out heart conditions.

Host: Right. Signs and symptoms, as you say, whether they're being caused by stress or not are probably not things that are good for us. So probably still best to reach out to our providers, right?

Meera Mohan, DNP: Yeah, absolutely.

Host: For sure. You know, we think about the risk factors for heart disease, right Meera? We're talking high blood pressure, high cholesterol, obesity, smoking, family history, the greatest hits if you will. Where does stress fit in when we think about that list there of things, of risk factors, where does stress fit in or rank, if you will, in terms of one of the risks?

Meera Mohan, DNP: Yeah, that's a great question. And to understand this question, it's important to know that stress can be divided into acute and chronic. So chronic stress is stress that's experienced for an extended period of time, usually more than six months. There's a famous study. It's a seminal study called IINTERHEART. And in this study they looked about 14 or 15,000 people who had their first heart attack and compared them to 14 or 15,000 people who did not have a heart attack.

And then they asked all of these patients a range of questions, including psychosocial factors such as stress. The researchers actually found out that those who had increased stress for the past year, had more than a twofold increased risk for having a heart attack. And that's controlling for factors such as socioeconomic factor status, lifestyle factors, geographic region, age, sex.

 From the study, we now know that chronic stress is actually an independent risk factor for cardiovascular disease. Now, when we're talking about acute stress, acute stress is experienced due to a short term event, which is usually less than a week.

Host: Hmm. Right.

Meera Mohan, DNP: In these situations, those who already have risk factors like high blood pressure, high cholesterol, tobacco use, some of the ones that you mentioned; they have an increased risk for a cardiovascular event such as a heart attack or stroke during an acute event.

Host: Okay. Yeah, I see what you mean. I think I'm following you here. So the chronic stress in and of itself could be a risk factor, but if we're already at risk because of that list, some of the things on that list or all of them, hopefully not, but perhaps all of them, then you add in the acute stress; you see how you could have an event, if you will, you know, hopefully not a life-threatening one, but you know, not a good one. Right?

Meera Mohan, DNP: Yeah. They've even found in research that in situations like an earthquake or even a soccer world cup that there was an increase of cardiovascular events around that time two to threefold.

Host: Hmm.

Meera Mohan, DNP: So very interesting.

Host: It is interesting. Yeah. We start thinking about the wildfires in California. We could do a a whole separate podcast. You just, yeah, just on acute stress, and I think I know the answer to this one, Meera, but are men and women different, right? Or are they typically affected equally by stress when it comes to their heart health?

Meera Mohan, DNP: So the answer is no. Men and women are not affected equally. It's important to remember, that women have a different set of hormones, which is evident in the fact that they have menstrual cycles. They can become pregnant, they go through postpartum periods, they experience menopause, and these hormones affect how stress plays a role in their bodies.

For example, in women, their immune systems when exposed to stress cause a greater inflammatory response to stress. There's also large vessels and small vessels that supply blood to our heart. In women, stress has a greater effect on the microvasculature or the small vessels that supply blood to our coronary arteries.

And this can result in conditions like ischemia and non-obstructive coronary artery disease, which is a situation where women can have chest pain, but then when they undergo an angiogram, there's no significant obstruction, or blockage found. It can also lead to something called mental stress-induced myocardial ischemia.

And this is a situation where stress can trigger reduced blood flow to the heart, and that can be seen on nuclear images. And there's two conditions if we have time that I'd like to touch on, that's more common among women as well. And that's called spontaneous coronary artery dissection or SCAD.

 This is a situation that's more common among young women. They typically don't have many risk factors, and it's a condition where the lining of the blood vessel tears or blood forms within the walls of the coronary arteries. This is more common among women under 50, and it's the most common cause of heart attack during pregnancy and postpartum.

And then the last condition is called stress cardiomyopathy, or broken heart syndrome. And this is a condition that's more common in women. And it's a situation where the heart muscles actually become stunned due to a surge of neurotransmitter releases that are released due to a period of intense emotional or physical stress.

So, women do experience it differently and that should be considered.

Host: So then Meera, let's talk about sort of first line or frontline for all of us, right? Patients, if you will, men, women, whomever. What do you suggest that we do if stress is affecting our hearts?

Meera Mohan, DNP: You know, for the reasons that we talked about, it can be hard to tease out which symptoms are the result of stress alone or which symptoms are due to cardiovascular disease. So, I would say that if someone is having symptoms like chest pain, shortness of breath, especially with activity, palpitations, it doesn't hurt to see a cardiologist to rule out heart disease.

You know, based on these symptoms, a cardiologist may order an EKG, recommend a stress test, or order a monitor to record a person's heart rhythm. But, if all of these come back normal, then at least we all can have a peace of mind that the cause of these symptoms are not due to the heart.

Host: Right.

Meera Mohan, DNP: That in and of itself can reduce stress.

Host: Oh my goodness. Of course. Right? Finding out it's not our hearts. It may be stress, could acute, could be chronic. We may still have some work to do, but at least it's not our hearts per se. So is that really then, when we're trying to figure out like, okay, you know, I, I'm feeling stressed, I'm feeling effects in my heart, things maybe just not firing properly. Is that when we should reach out to our doctors if we think that stress is impacting our physical health?

Meera Mohan, DNP: Yeah, absolutely. I would recommend a person talking to their doctor if they notice that the stress and the symptoms are impacting their quality of life. If it affects how they perform their daily activities. How it affects them when they're cleaning their home or going to the grocery store, or even going to work.

 So if it does affect their quality of life, then we know that their symptoms are severe enough to initiate further investigation.

Host: Right. Let's just finish up today and talk about maybe some from a lifestyle perspective, like what can we do to help cope with stress and heart health? I'm sure meditation's on your list, that kind thing, you know. But, uh, get it from an expert, like, what should we do to deal and cope with stress?

Meera Mohan, DNP: Yeah, so it's interesting. When we feel stressed, we engage certain parts of our brain that release chemicals and hormones. There's also the front part of our brain, the prefrontal cortex, which helps to mitigate the responses of stress. So when we engage, or when we are involved in stress management techniques, we're actually engaging that prefrontal cortex.

And when I say stress management techniques, I'm talking about the ones that you mentioned. Meditation, exercise, consuming a healthier diet, getting good enough sleep, spending time outdoors. But I think there's also another important lifestyle management approach and that's addressing loneliness.

You know, the previous Surgeon General declared loneliness was a national public health epidemic in our country. Nearly half of Americans suffer from loneliness. Loneliness can exacerbate stress and it can lead to heart disease. So another very important coping mechanism is re-engaging with our families and communities, reaching out to our friends and being a good friend to others, helping our neighbor and also asking for help. So it's not only important to address stress at an individual level, but it's also to recognize that there's a community component to it.

Host: Right. I really appreciate your expertise and your time and just really understanding how stress can affect all of us. Sometimes in the short term, long term, whatever it might be. Reach out if, we think we're, you know, someone who needs to reach out, right, mentally, physically, whatever it is, help is out there, certainly at Franciscan Health. So thank you so much.

Meera Mohan, DNP: Absolutely. And Scott, if you don't mind, there's one last comment I'd like to leave. I just had a baby. My, I had a boy six months ago.

Host: Congratulations.

Meera Mohan, DNP: And thank you, thank you. And I often think about what I want for him. What I want for him is I'd like him to know that I have seen him before he figured out he likes peas and not bananas, before he can walk, before he even had a name. That there's a resilience and a value in him that's beyond any of the identities he might form for himself or others might form for him, and he's no doubt going to experience stress in his life, whether that's family, friends, financial, and I'd want him to know that by engaging and taking care of himself and managing his stress in the ways that we talked about, through exercise, food, that he is tapping into that part of himself. And that's what I wish for all our listeners, for everybody who steps into our cardiology clinic.

Host: Yeah, that's well said. I really appreciate your time. Thank you so much.

Meera Mohan, DNP: Thank you. Thank you so much, Scott.

Host: And for more information, visit franciscanhealth.org and search Healthy Heart.

And if you found this podcast helpful, please share it on your social channels, and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.