Stress and anger can worsen heart failure

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In a new study from Yale, researchers found that mental stress and anger may have clinical implications for patients with heart failure.

Heart failure is a life-threatening cardiovascular disease in which the heart is damaged or weakened.

This can lead to a reduced ejection fraction, in which the heart muscle pumps out a lower amount of blood than is typical with each contraction.

In this study, the team tested patients who had heart failure with reduced ejection fraction.

They evaluated the effects of stress and anger on diastolic function. Diastolic function describes the ability of the heart to relax and refill between muscle contractions and is predictive of mortality risk.

For one week, participants completed daily questionnaires about their experiences of stress, anger, and negative emotions during the previous 24 hours.

Participants then completed a standardized “mental stress” protocol in which they solved challenging arithmetic problems and described a recent stressful experience.

Echocardiograms were performed to assess diastolic function at rest and during the stress task.

The team found patients who reported experiencing anger in the week prior to the laboratory mental stress showed worse resting diastolic pressure.

Furthermore, most patients showed stress-provoked changes in diastolic function, including decreased early relaxation and increased diastolic pressure.

The team says mental stress is common in patients with heart failure due in part to the complexities of disease self-management, progressively worsening functional limitations, and frequent symptom exacerbations and hospitalizations.

People who experience chronically elevated levels of stress experience a more burdensome disease course with diminished quality of life and increased risk for adverse events.

Clarifying the relevant behavioral and physiological pathways is especially important in the era of COVID-19 when the typical stressors of heart failure may be further compounded by pandemic-related stressors.

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The study is published in the Journal of Cardiac Failure. One author of the study is Kristie Harris.

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