HYANNIS – Stress-related heart and vascular conditions were in the news this week, with the death from a stroke oflong-time Hollywood actress Debbie Reynolds, just one day after her daughter, actress and author Carrie Fisher, had died of cardiac arrest. In 2015, we explored this issue with a group of cardiac rehabilitation patients and Cape Cod Hospital cardiologist Elissa Thompson, MD.
They went around the room, explaining the reasons for their heart attacks.
“I smoked two packs of cigarettes a day.”
“I knew I should have gotten more exercise.”
“I was 50 pounds overweight.”
“I didn’t watch my blood pressure.”
“I was a football player through college. I thought I was invincible.”
Throughout the hour-long session, Paulette Aronson had remained silent and tense. When it was her turn, she spoke in a confessional whisper. “I’m almost too embarrassed to say this, but my heart attack is different than all yours,” she said. “Stress broke my heart.”
“I had been feeling great stress for a while,” she explained. “My daughter lost her job and moved back into my home – and then, my dog died.
“My doctor described it as the perfect storm. I always have been a Type-A personality. I stressed about work, my family, even the little things. But all these recent events just triggered a traumatic shock to my system.”
Emotional stress can alter heart function in a seeming instant, while also contributing to longer-term heart-disease risks, said Elissa Thompson, MD, medical director of Cape Cod Hospital’s Cardiology Rehabilitation Program.
Aronson and her fellow patients were participating in Cape Cod Healthcare’s three-month cardiac rehabilitation program that launched late last year at the Heart and Vascular Institute. It includes three supervised conditioning sessions a week along with classes ranging from weight and cholesterol management to nutrition and stress control.
Dr. Thompson holds the sessions to allow patients to share their own fears, insecurities, anxieties and hopes on the long path toward recovery in the wake of devastating heart attacks.
As part of the program, Dr. Thompson meets in a living-room-like environment to answer patients’ questions and devote as much time as needed to explain their new world – from how to cope with life-saving but debilitating drugs to the physical and emotional pain that could persist a year after heart surgery, or even longer.
In Aronson’s case, she was fortunate in one way. She didn’t require extraordinary surgery like many of her fellow patients whose heart attacks were caused by coronary artery disease. She didn’t even need a stent.
Instead, she experienced Takotsubo cardiomyopathy, also known as broken-heart syndrome, a temporary weakening of the muscular portion of the heart triggered by a traumatic event such as the death of a loved one, a break-up, extreme anxiety or anger.
“This syndrome happens mainly in women, when waves of stress hormones essentially overtake your cardiovascular system,” explained Dr. Thompson.
When it first happened to Paulette, she was at work in Hyannis.
“At first, I felt mild discomfort in my chest. It felt like the asthma symptoms I sometimes suffered from allergies. My elbow then felt like I suddenly sprained it. Every few seconds it would make my fingertips numb. Then, my jaw started getting numb on one side. That’s when I knew I was in trouble.”
She drove herself across the street to Cape Cod Hospital. “I was in disbelief when I was told I had just had a heart attack.”
Individuals react very differently to stress based on personality type or other psychological stressors. For instance, people who suffer from depression or a pessimistic outlook are more likely than others to suffer heart attacks or sudden heart death, according to a study reported in The Lancet medical journal.
Will this happen again to Paulette?
She is continuing to watch her weight and improve her physical conditioning, but her particular challenge on the road to recovery will depend on how she alters a lifetime of worry.
Her primary care physician has put her on anti-anxiety medicine. She is practicing meditation and deep-breathing exercises. She’s visited a therapist to “talk through some things.” Her daughter has ordered her a yoga chair. She’s even downloaded several meditation Apps to her smart phone.
When the 12-week rehabilitation program ends, Paulette, like many of her fellow patients, plans to join a health club and hopefully find workout partners to support each other.