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February
23, 2009
Anger Management: The Key to Staying Heart Healthy?
Study provides first evidence that changes brought
on by anger
can predict future arrhythmias
WNew research published in the March 3, 2009, issue of the
Journal of the American College of Cardiology finds
that anger-induced electrical changes in the heart can predict
future arrhythmias in patients with implantable cardioverter-defibrillators
(ICDs).
While previous studies have demonstrated an increased incidence
of sudden cardiac death during times of population stress
such as earthquake and war, this study provides the first
evidence that changes brought on by anger and other strong
emotions can predict arrhythmias and may link mental stress
to sudden cardiac arrest--which accounts for over 400,000
deaths each year.
“It’s an important study because we are beginning
to understand how anger and other types of mental stress can
trigger potentially lethal ventricular arrhythmias, especially
among patients with structural heart abnormalities,”
says Rachel Lampert, M.D., F.A.C.C., associate professor,
Yale University School of Medicine.
Researchers studied 62 patients with ICDs who underwent monitoring
during a mental stress test. Patients who had coronary artery
disease or dilated cardiomyopathy (a condition in which the
heart muscle are enlarged) and a standard indication for ICD
were recruited from the Yale Electrophysiology practice. The
mental stress test, conducted in a laboratory setting shortly
after ICD implantation (about 3 months), asked patients to
recall a recent situation in which they were angry or aggravated.
T-wave alternans (TWA), a measure of the heart’s electrical
stability, was analyzed during this test. Researchers then
followed patients for a mean of 37 months to determine which
had arrhythmias requiring termination by the ICD.
“We know strong emotion increases sympathetic arousal,”
says Dr. Lampert. “In this study, we found patients
with higher levels of anger-induced TWA were more likely to
experience arrhythmias requiring ICD termination.”
Patients with ICD-terminated arrhythmias during follow up
(16%) had higher TWA induced by anger compared with those
patients who did not have future arrhythmias. Even when other
clinical factors that predispose patients to higher TWA levels
and/or higher risk of ventricular tachycardia/ventricular
fibrillation were controlled for (e.g., heart failure or history
of arrhythmia), anger-induced TWA remained a significant predictor
of arrhythmias, which led to a heightened risk of up to ten
times that of other patients.
The development of accurate, non-invasive risk stratification
tests to identify those individuals at greatest risk for life-threatening
arrhythmia is critical. The present study suggests that mental
stress, namely anger, may be yet another pathway provoking
arrhythmias.
"What remains unclear is how this new T-wave alternans
test relates to traditional exercise TWA testing,” according
to Eric J. Rashba, M.D., professor of Medicine, Stony Brook
University Medical Center. “It may be that combining
exercise TWA tests with newer mental stress TWA tests may
help clinicians better select patients likely to have arrhythmia
and, in turn, benefit from a defibrillator; however, more
study is needed."
In contrast to exercise, mental stress doesn’t elevate
one’s heart rate much, suggesting that changes seen
with mental stress may be due to a direct effect of adrenaline
on the heart cells. Therefore, mental stress testing could
provide an alternative to atrial pacing for patients unable
to exercise, according to Dr. Lampert.
“More research is needed, but these data suggest that
therapies focused on helping patients deal with anger and
other negative emotions may help reduce arrhythmias.
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cardiovascular care and disease prevention. The College is
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credential Fellow of the American College of Cardiology upon
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research. The ACC provides professional education and operates
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online at www.acc.org .
The American College of Cardiology (ACC) provides these news
reports of clinical studies published in the Journal of
the American College of Cardiology as a service to physicians,
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statements or opinions expressed in these reports reflect
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