Stress and heart disorders

STRESS AND HEART DISORDERS

DR FRANCISCA INOFOMOH SENIOR REGISTRAR

CARDIOLOGY

HELLOHELLO HEART !HEART !

ARE YOU THERE ?ARE YOU THERE ?

When did you say this last?When did you say this last?

05/01/2305/01/23 22DR FRANCISCA DR FRANCISCA OLUFUNMILAYO INOFOMOHOLUFUNMILAYO INOFOMOH

GENERAL PRINCIPLESGENERAL PRINCIPLES

FORMED BY THE FIRST WEEK IN FORMED BY THE FIRST WEEK IN UTERUS,,,, gives life to the fetusUTERUS,,,, gives life to the fetus

the first organ in the bodythe first organ in the body the last organ to stop (‘brain death’)the last organ to stop (‘brain death’)


GENERAL PRINCIPLESGENERAL PRINCIPLES

WORKS THROUGHOUT LIFEWORKS THROUGHOUT LIFE

does not necessarily ‘beat’ thru lifedoes not necessarily ‘beat’ thru life

RESTS!- NOT ACTIVE RESTRESTS!- NOT ACTIVE REST systole 0.3 secs (beat)systole 0.3 secs (beat) diastole 0.5 secs (rest)- rests 37.5 secs/min diastole 0.5 secs (rest)- rests 37.5 secs/min

*REST IS PARTICULARLY AFFECTED BY *REST IS PARTICULARLY AFFECTED BY STRESSSTRESS


ON THE AVERAGEON THE AVERAGE Heart beats 75times/minHeart beats 75times/min 75x60x24=108,000 times/day75x60x24=108,000 times/day 39,420,000 times/year39,420,000 times/year 2,759,400,000 times for a life span 2,759,400,000 times for a life span

of 70 years!of 70 years!


STRESS AND HEART STRESS AND HEART DISORDERDISORDER

DEFINITIONDEFINITION STRESS-UNDUE, INAPPROPRIATE OR STRESS-UNDUE, INAPPROPRIATE OR

EXAGERRATED RESPONSE TO EXAGERRATED RESPONSE TO SITUATION.SITUATION.

MAY LEAD TO PHYSIOLOGICAL AND/OR MAY LEAD TO PHYSIOLOGICAL AND/OR PSYCHOLOGICAL REACTIONS IN OUR PSYCHOLOGICAL REACTIONS IN OUR BODY SYSTEMSBODY SYSTEMS


Stress ALSO Defined as failure of behavioral, Stress ALSO Defined as failure of behavioral, physiological and psychological adaptation to physiological and psychological adaptation to a challenge .a challenge .

Whereas anxiety about a situation could be Whereas anxiety about a situation could be positive, stress is always negative with positive, stress is always negative with attending adverse psychological and attending adverse psychological and physiological changes leading to decreased physiological changes leading to decreased productivity, disease and sometimes death.productivity, disease and sometimes death.


STRESS INCREASES BEATING/ RATE OF STRESS INCREASES BEATING/ RATE OF THE HEART- THEREBY INCREASING THE HEART- THEREBY INCREASING THE WORK RATE- CAUSING UNDUE THE WORK RATE- CAUSING UNDUE STRAIN ON THE HEART- MAKING IT TO STRAIN ON THE HEART- MAKING IT TO BE PRONE TO DISEASES AND BE PRONE TO DISEASES AND SHORTENING ITS LIFE SPAN! SHORTENING ITS LIFE SPAN!


PREDISPOSITIONPREDISPOSITION

*AGE- 3R*AGE- 3RDD -5 -5THTH DECADE DECADE *SEX-FEMALE > MALE*SEX-FEMALE > MALE * PSYCHOLOGICAL TYPE A, group with * PSYCHOLOGICAL TYPE A, group with

overambition, high hopes and difficult targetsoverambition, high hopes and difficult targetsCONTRIBUTORY*ObesityCONTRIBUTORY*Obesity *Smoking*Smoking *Sedentary living *Sedentary living *High cholesterol diet*High cholesterol dietTORY FACTORS,TORY FACTORS,

1212DR FRANCISCA DR FRANCISCA OLUFUNMILAYO INOFOMOHOLUFUNMILAYO INOFOMOH

COMMON SOURCES OF STRESSCOMMON SOURCES OF STRESS

PEER AND SOCIAL PRESSURESPEER AND SOCIAL PRESSURES DELAYS- marital,children,promotionDELAYS- marital,children,promotion WORK SITUATIONSWORK SITUATIONS unfufilmentunfufilment poor growth potentialspoor growth potentials unsecured futureunsecured future inappropriate capacity utilizationinappropriate capacity utilization hostile job environmenthostile job environment PARENTAL/HOME FRONTPARENTAL/HOME FRONT PSYCHOLOGICAL MAKE UPPSYCHOLOGICAL MAKE UP


Top Ten Stressful Life Events

1. Spouse’s death2. Divorce3. Marriage separation4. Jail term5. Death of a close relative6. Injury or illness7. Marriage8. Fired from job9. Marriage reconciliation10. Retirement

Source: Holmes-Rahe Life Stress Inventory

Common external causes of stress

Major life changesWorkRelationship difficultiesFinancial problemsBeing too busyChildren and family

Common internal causes of stress Inability to accept uncertainty PessimismNegative self-talkUnrealistic expectationsPerfectionismLack of assertiveness

Not all stress is caused by external factors.Stress can also be self-generated


http://www.geocities.com/beyond_stretched/holmes.htm

http://www.geocities.com/beyond_stretched/holmes.htm

Stress Adrenergicresponse

FrightFlightFight

RateBPDamage

When you perceive a threat, your nervous system responds by releasing a flood of stress hormones, including adrenaline and cortisol. These hormones rouse the body for emergency action. Your heart pounds faster, muscles tighten, blood pressure rises, breath quickens, and your senses become sharper. These physical changes increase your strength and stamina, speed your reaction time, and enhance your focus – preparing you to either fight or flee from the danger at hand.


STRESS AND HEART DISORDERS• CHECK YOUR HEART

• ARE YOU STILL BEATING, HEART?!!!

05/01/23 16DR FRANCISCA OLUFUNMILAYO INOFOMOH

STRESS AND HEART DISORDERSTRESS AND HEART DISORDER

HYPERTENSIONHYPERTENSION +CARDIAC FAILURE+CARDIAC FAILURE + HEART ATTACK+ HEART ATTACK +STROKE+STROKE +ARRYTHMIAS+ARRYTHMIAS + KIDNEY FAILURE+ KIDNEY FAILURE


But beyond a certain point, stress stops being helpful and starts causing major damage to your health, your mood, your productivity, your relationships, and your quality of life.

The stress response is the body’s way of protecting you. When working properly, it helps you stay focused, energetic, and alert. In emergency situations, stress can save your life – giving you extra strength to defend yourself, for example, or spurring you to slam on the brakes to avoid an accident.

The stress response also helps you rise to meet challenges. Stress is what keeps you on your toes during a presentation at work, sharpens your concentration when you’re attempting the game-winning free throw, or drives you to study for an exam when you'd rather be watching TV.

STRESS RESPONSE

PROTECTS,

ENHANCES,

ULTIMATELY DAMAGES.


STRESS AND HEART STRESS AND HEART DISORDERDISORDER

S- SORROWS- SORROW T- TROUBLET- TROUBLE R- REPROACHR- REPROACH E- ENDSE- ENDS S- SLOWLYS- SLOWLY S- SUICIDES- SUICIDE


Prolonged Severe Stress

Strains the HeartWeakens immune systemDamages memory circuits in brainPromotes mid-truncal obesity


Work Stress and Cardiovascular Disease

Cardiovascular diseases (CVD) are the leading cause of death in the World.

Together, heart disease, stroke, and related diseases are responsible for 35% of all deaths.

Considerable evidence has demonstrated that occupational stress contributes to CVD morbidity and mortality.

Clinicians, however, usually do not consider occupational stress as a preventable risk factor for CVD.


I AM NOT A SAINT!!!• Social expectation- The doctor is still perceived as a very

comfortable person in our society and expectations are usually high financially and otherwise. Failure or inability to ‘meet up’ may constitute a significant stress factor in some physicians.

• Training- Both the undergraduate and postgraduate trainings are long and tedious. Getting into the few medical schools is like passing through the proverbial eye of the needle, yet the remunerations and the social acceptance is not commensurate.

• Hostile Job Environment- Administrative ineptitude and bureaucratic bottlenecks can make the job situation very frustrating

• Many doctors share, identify and empathise with their patients’ burden of suffering, inadequate financial and material for treatment. This could create a stressor.

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Today an Executive is considered a ….

Corporate Investment

Career Climber

Money spinner

Family provider

A loving father & a husband


..But underneath all that,

He is a man with a

HEART


STRESS AND HEART DISORDERS• CHECK YOUR HEART

• ARE YOU STILL BEATING, HEART?!!!

05/01/23 DR FRANCISCA OLUFUNMILAYO INOFOMOH

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Stress is like a violin stringToo tight it will snapToo loose it is a limp stringRight tension, life is a concert !

05/01/2305/01/23 DR FRANCISCA DR FRANCISCA OLUFUNMILAYO INOFOMOHOLUFUNMILAYO INOFOMOH

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Being Angry, Stressed Can Cause Irregular Heart Beat


INDIVIDUAL RESPONSE TO INDIVIDUAL RESPONSE TO STRESSSTRESS

SmokingSmoking AlcoholAlcohol Late nights (“out with the boys”)Late nights (“out with the boys”) Intense seclusion (“keeping to myself”Intense seclusion (“keeping to myself” Extra marital affairs( “listening voice”)Extra marital affairs( “listening voice”) Intense religiosityIntense religiosity Unstable jobUnstable job Poor work outputPoor work output Suicidal tendencies Suicidal tendencies


SYMPTOMS AND SIGNS OF SYMPTOMS AND SIGNS OF HARMFUL STRESSHARMFUL STRESS

GENERALGENERAL *Loss of weight*Loss of weight *irritable*irritable *talkativeness/withdrawal*talkativeness/withdrawal CNSCNS *Loss of concentration*Loss of concentration *Sleep disorder*Sleep disorder *Tension headache*Tension headache *Excessive palmar sweating*Excessive palmar sweating *Crawling sensation*Crawling sensation


SYMPTOMS AND SIGNS OF SYMPTOMS AND SIGNS OF HARMFUL STRESSHARMFUL STRESS

GITGIT *Diarrhea*Diarrhea *Dyspepsia*Dyspepsia GUSGUS *Irregular menses*Irregular menses *Phantom pregnancy*Phantom pregnancy CVSCVS *Tachycardia*Tachycardia *Palpitation*Palpitation *Cardiac neuroses*Cardiac neuroses *Hypertension*Hypertension


•Backache/body pain•Change in appetite•Fatigue•Headache•Stomach upsets•Sleep disorders•Weight loss


Stress Warning Signs and Symptoms

Cognitive Symptoms

Memory problemsInability to concentratePoor judgmentSeeing only the negativeAnxious or racing thoughtsConstant worrying

Emotional Symptoms

MoodinessIrritability or short temperAgitation, inability to relaxFeeling overwhelmedSense of loneliness and isolationDepression or general unhappiness

Physical Symptoms

Aches and painsDiarrhea or constipationNausea, dizzinessChest pain, rapid heartbeatLoss of sex driveFrequent colds

Behavioral Symptoms

Eating more or lessSleeping too much or too littleIsolating yourself from othersProcrastinating or neglecting responsibilitiesUsing alcohol, cigarettes, or drugs to relaxNervous habits (e.g. nail biting, pacing)05/01/2305/01/23 3535DR FRANCISCA DR FRANCISCA

OLUFUNMILAYO INOFOMOHOLUFUNMILAYO INOFOMOH

MANAGEMENTMANAGEMENT

Non- PharmacologicalNon- Pharmacological *Physical exercise*Physical exercise *Rest (including holidays)*Rest (including holidays) *Counseling *Counseling (spiritual, (spiritual,

guidance, professional) guidance, professional) *Diet ( Cholesterol)*Diet ( Cholesterol) *weight*weight


The mantra of stress management


Relaxation Response (RR) techniques is defined as a set of Relaxation Response (RR) techniques is defined as a set of integrated physiological mechanisms and adjustments that are integrated physiological mechanisms and adjustments that are elicited when a subject engages in repetitive mental or elicited when a subject engages in repetitive mental or physical activity while passively ignoring distracting physical activity while passively ignoring distracting thoughts(12). RR includes such activities as Yoga, thoughts(12). RR includes such activities as Yoga, transcendental meditation, repetitive prayers and autogenic transcendental meditation, repetitive prayers and autogenic training (self hypnosis). It has proven useful in managing training (self hypnosis). It has proven useful in managing chronic stress and known to reduce oxygen consumption, chronic stress and known to reduce oxygen consumption, lower heart rate, arterial blood pressure and respiratory rate. It lower heart rate, arterial blood pressure and respiratory rate. It has also been shown to decrease norepinephrine, cortisol and has also been shown to decrease norepinephrine, cortisol and probably iNO; which are produced in excess during chronic probably iNO; which are produced in excess during chronic stressstress


You may feel like the stress in your life is out of your control, but you can always control the way you respond.

Managing stress is all about taking charge: taking charge of your thoughts, your emotions, your schedule, your environment, and the way you deal with problems.

Stress management involves changing the stressful situation when you can,changing your reaction when you can’t, taking care of yourself, and making time for rest and relaxation

How to manage stress?


Good companyHumourFreeze FrameTai – ChiYogaMeditation05/01/2305/01/23 4343DR FRANCISCA DR FRANCISCA


When you have trusted friends and family members you know you can count on, life’s pressures don’t seem as overwhelming. So spend time with the people you love and don’t let your responsibilities keep you from having a social life.

If you don’t have any close relationships, or your relationships are the source of your stress, make it a priority to build stronger and more satisfying connections.

Tips for reaching out and building relationships:•Help someone else by volunteering.•Have lunch or coffee with a co-worker.•Call or email an old friend.•Go for a walk with a workout buddy.•Schedule a weekly dinner date•Take a class or join a club.

Strengthen your relationships

A strong support network is your greatest protection against stress.


Your support network – A strong network of supportive friends and family members is an enormous buffer against life’s stressors. On the flip side, the more lonely and isolated you are, the greater your vulnerability to stress.

Your sense of control – If you have confidence in yourself and your ability to influence events and persevere through challenges, it’s easier to take stress in stride. People who are vulnerable to stress tend to feel like things are out of their control.

Your attitude and outlook – Stress-hardy people have an optimistic attitude. They tend to embrace challenges, have a strong sense of humor, accept that change is a part of life, and believe in a higher power or purpose.

Your ability to deal with your emotions. You’re extremely vulnerable to stress if you don’t know how to calm and soothe yourself when you’re feeling sad, angry, or afraid. The ability to bring your emotions into balance helps you bounce back from adversity.

Your knowledge and preparation – The more you know about a stressful situation, including how long it will last and what to expect, the easier it is to cope. For example, if you go into surgery with a realistic picture of what to expect post-op, a painful recovery will be less traumatic than if you were expecting to bounce back immediately.

Things that influence your stress tolerance level


My Life is in the hands of any foolWho chooses to irritate me

-John Hunter•Stress is a normal physiological reactionTo changes in internal & external milieu

•We all experience stress on a daily basis

•Key to controlling stress is how we handle it


Lower CaloriesLow fat diet (30% of cal)Avoid saturated fatty acids (ghee, animal fats etc.)Steamed food over fried foodNatural cardioprotective supplements(beta-carotenes, antoxidants, vitC, Folate, zinc etc)Avoid too much sodium


RECOMMENDATIONS FOR PHYSICAL ACTIVITY FOR ADULTS

• Centre for Disease Control (CDC) & National Institutes

of Health (NIH) suggest adults should

exercise , at least 30 – 45 mins of brisk walking , bicycling

or working around the house or yard on all days of the week


• Physical inactivity roughly doubles the risk forCoronary heart disease.

• Moderate to intense exercise reduces fat deposition in the blood vessels and also maintainsthe blood flow by widening the blood vessels.

• The overall risk of myocardial infarction and sudden cardiac death is reduced among those who regularly exercise

Why Exercise ? BENEFITS OF EXERCISE


BENEFITS OF PHYSICAL ACTIVITY IN ADULTS

• Reduces risk of dying prematurely

• Reduces risk of dying from heart disease

• Reduces risk of developing diabetes

• Reduces risk of developing high blood pressure

• Helps reduce blood pressure in people who already have high blood pressure


BENEFITS OF PHYSICAL ACTIVITY IN ADULTS

Other documented health benefits include

• Reduces risk of developing colon cancer

• Reduces feelings of depression & anxiety

• Helps control weight

• Helps built healthy bones , muscles & joints

• Helps older adults become stronger & able to move

about freely

• Promotes physiological well-being 05/01/2305/01/23 5151DR FRANCISCA DR FRANCISCA


Cigarette smoking increases risk 2-3 fold and interacts with other risk factors to multiply risk


“The French Paradox”Red Wine= 2 glasses/WEEKMakes blood less sticky, reduces LDL,Has antioxidant - bioflavinoids


Sex and HeartSex does not adversely affect the heart,Sexually transmitted diseases do

Use of “Viagra” in known heart patientsCan cause fatalities

Normal Sexual activity can be resumedAfter heart attacks and heart surgery


Health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity.Constitution.

The World Health Organization05/01/2305/01/23 5656DR FRANCISCA DR FRANCISCA


PHARMACOLOGICAL PHARMACOLOGICAL MANAGEMENTMANAGEMENT

ANXIOLYTICSANXIOLYTICS

B- BLOCKERSB- BLOCKERS

NEUROLEPTICSNEUROLEPTICS


ROUTINE SCREENING TESTSROUTINE SCREENING TESTS

• Chest x-ray• Routine ECG• Stress ECG• Echo cardiogram• Serum lipid profile


CONCLUSIONCONCLUSION

Keep a SOUND mind in a SOUND bodyKeep a SOUND mind in a SOUND body BE AT PEACE WITH GOD AND WITH BE AT PEACE WITH GOD AND WITH

YOURSELFYOURSELF


APPRECIATION!!!

• THANK YOU!

• GOD BLESS YOUR HEARTS!

05/01/23 62DR FRANCISCA OLUFUNMILAYO INOFOMOH

Stress and heart disorders

Education

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