Issued by Harvey Heart Hospital,(A unit of Harvey Healthcare ltd,Chennai, India)

Dr.M.P.Naresh Kumar MS MCh FRCS FIACSChief Cardiac Surgeon, Harvey Heart

This advisory tries to highlightThe issues of workplace wellnessAnd how it can affect the well being of the heart

The mantra of stress management

Modern life is full of hassles, deadlines, frustrations, and demands.

For many people, stress is so commonplace that it has become a way of life.

Stress isn’t always bad. In small doses, it can help you perform under pressure and motivate you to do your best.

But when you’re constantly running in emergency mode, your mind and body pay the price.

Stress Adrenergicresponse

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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.

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.

The Definition of "Stress”

A specific response by the body to a stimulus, such as pain or fear, that disturbs or interferes with the normal physiological equilibrium of an organism.

It is estimated that 75% to 85% of all medical problems are related to stress.

Chronic job stress may be bad news for your heart, especially if your lifestyle isn't healthy.

12-year study of more than 10,000 British government workers in white-collar jobs.

The bottom line: Workers were 68% more likely to die of heart disease , suffer a nonfatal heart attack, or develop angina (chest pain) if they had long-term job stress.

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

•Children•Death•Family•Financial issues•Health•Holidays•Life change•Marriage/Divorce•Moving •School•Time•Traffic•Work

The top two sources of stress among adults are work and family.

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

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

EMOTIONAL STRESS

Important New Findings According to a study by the British Medical Journal, chronic stress has been linked to the development of heart disease and type 2 diabetes, as well as other conditions.

Researchers followed 10,308 British civil servants aged 35-55 over a 14-year period to sutdy the role of chronic job stress in the development of heart disease and type 2 diabetes.They examined the link between chronic

job stress and metabolic syndrome, which is a group of factors that, together, increase the risk of these diseases, including high blood pressure, insulin resistance, central obesity (excessive abdominal fat, which has been linked to increased cortisol in the bloodstream, as well as several other health problems), and a few other factors.

They found that greater levels of job stress did indeed increase people’s chances of developing metabolic syndrome. The higher the stress level, the greater the chance of developing metabolic syndrome.

Prolonged Severe Stress

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

Effects of chronic stressThe body doesn’t distinguish between physical and psychological threats. If you have a lot of responsibilities and worries, your emergency stress response may be “on” most of the time. The more your body’s stress system is activated, the easier it is to trip and the harder it is to shut off.Long-term exposure to stress can lead to serious health problems.

Chronic stress disrupts nearly every system in your body. It can raise blood pressure, suppress the immune system, increase the risk of heart attack and stroke, contribute to infertility, and speed up the aging process. Long-term stress can even rewire the brain, leaving you more vulnerable to anxiety and depression.Many health problems are caused or exacerbated by stress, including:Pain of any kindHeart diseaseDigestive problemsSleep problemsDepressionObesityAutoimmune diseasesSkin conditions, such as eczema

Because of the widespread damage stress can cause, it’s important to know your own limit. But just how much stress is “too much” differs from person to person. Some people roll with the punches, while others crumble at the slightest obstacle or frustration. Some people even seem to thrive on the excitement and challenge of a high-stress lifestyle.

How much stress is too much?

Your ability to tolerate stress depends on many factors, including the quality of your relationships, your general outlook on life, your emotional intelligence, and genetics.

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

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.

Work Stress and Cardiovascular Disease

29 – 45 % of U.S. workers say that their work is very or extremely stressful. 25% of employees view work as their primary cause of stress (NIOSH). It is estimated that up to 23 percent of heart disease related deaths per year could be prevented if the levels of job strain in the most stressful occupations were reduced to average levels seen in other occupations (Karasek and Theorell, 1990; Landsbergis et al, 1993). Generally the correlations are

stronger for men than for women, although this may be because the biggest studies have not assessed sexual harassment, work- family imbalance, and other stressors that especially affect women.

How common is job stress?

Cope with Grope

JobStress

Health

Cost

Productivity

Society

Job stress

National Institute of Occupational Health and Safety

TOP TEN

-Work Stress and Health

ConferenceSept 1995

1. Too much / Too little2. Lack of 2 way communication3. Lack of appreciation4. Inconsistent performance management processes5. Career & job ambiguity6. Unclear company direction & policies7. Mistrust8. Doubt9. Random interruptions10.Treadmill syndrome – 24 hr workday

High-flying career women with stressful jobs are twice as likely to suffer from heart disease and the risk is greater with younger women, a new study has claimed.Researchers at Glostrup University Hospital in Denmark found that women who feel the pressure at work is "much too high" are 50 per cent more likely to suffer heart disease than their peers who say their job is manageable.

Are women exempt fromRavages of Job Stress?

Being Angry, Stressed Can Cause Irregular Heart Beat

The profile: You're busy from the time you get to work until the time you leave, but you have little freedom while you're there. You don't have much say over how you do your job or the types of projects you work on, and you're always on someone else's schedule.The solution: These types of jobs—known as "high-demand, low-control"—tend to cause a great deal of psychological strain.Even if you can't make your job less demanding, finding ways to get more involved in decision-making will help ease the stress, research suggests.

Overworked underling

The profile: You work your tail off, but you feel you don’t receive enough credit—or compensation. With lots of sweat (and maybe a few tears), you’ve made your bosses look good. Still, you haven’t received a raise, a promotion, or sufficient recognition.The solution: These so-called "effort-reward imbalances" are a recipe for stress, especially among very driven people who are eager for approval.Try discussing your career goals with your boss. You may not get the rewards you want right away, but you could gain some insight about how to improve your situation—and outlook.

Frustrated go-getter

The profile: You feel like you’re all alone, and not in a good way. If you require help or guidance, your boss won’t give it to you, and when you need to vent, you don’t have a trusted ally to turn to.The solution: A good support system at work includes both practical support from your bosses (the resources and help you need to do your job well) and emotional support from colleagues. Too little of either could make you feel stranded on irritation island.Work on communicating your needs, both practical and emotional. If you want your boss’s help, be as specific (and persuasive) as possible, and make connecting with co-workers a priority.

Castaway

The profile: You deal with demanding and verbally abusive customers, but through it all you’re expected—no, required—to swallow your resentment and maintain a facade of professionalism, calm, and courtesy.The solution: "When there’s a discrepancy between your internal state and the roles you’re expected to play at work, you experience what researchers call ‘emotional labor,’Ask your boss for advice or additional training on how to handle difficult customers without feeling demoralized. Doing your job without taking abuse personally will leave you feeling better about yourself.

Door Mat

The profile: You’re terminally exhausted, both physically and emotionally, to the point where it becomes difficult to function. You feel as if you’re on the verge of a breakdown.The solution: Although the word "burnout" is used loosely, the technical definition is severe exhaustion stemming from prolonged work-related stress. Burnout occurs most often in very charged, high-stakes work environments (such as ERs). But it can occur in just about any stressful job.If you’re experiencing burnout, discuss it with a supervisor and explore whether you can take time off or even a leave of absence.

Burnout

The profile: Work just isn’t fair. Your boss plays favorites, management decisions are mystifying and arbitrary, and employees are treated like children.The solution: Workplaces that aren’t fair, transparent, and respectful lack what’s known as “organizational justice,” and they’re likely to have stressed-out employees. “Pretty much anytime an individual feels they are being dealt with differently or unfairly, it places potentially harmful stress on them,” You only have so much control over the atmosphere at work. However, raising your concerns with a trusted superior or HR rep may leave you feeling less burned out—and less stressed.

Wronged victim

The profile: Your boss insults you, gives you impossible deadlines, assigns you busywork just because she can, and dresses you down in front of your colleagues. Or you’ve seen her do those things to others—and you’re worried that you’re next.The solution: Bullying isn't restricted to the playground; it appears to be on the rise in offices too. If you feel you're the victim of a bullying boss, you can try to mollify him or confront him as a group

Bully target

The profile: Thanks to the Blackberry, cell phone, and laptop your company so generously provided, your boss can now reach you 24/7. You're constantly (if virtually) connected to the office, and your work and personal life are indistinguishable.The solution: “Technostress is an important and growing issue,” To protect yourself from mental and physical strain, learn how to unplug (literally). Set aside blocks of time when ou turn your electronics off.

Tech prisoner

Men who bottle up their anger at being unfairly treated at work are up to five times more likely to suffer a heart attack, or even die from one, than those who let their frustration show, a Swedish study has found.

Covert coping was listed as "letting thing pass without saying anything" and "going away" despite feelings of being hard done by colleagues or bosses.

Men who often used these coping techniques had a two to fivefold higher risk of developing heart disease than those who were more confrontational at work, the study showed.

Covert Coper or Overt confronter

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

•Anxiety•Hostility•Irritability•Loss of concentration•Loss of self esteem•Social withdrawal•Withdrawal from family & friends

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)

How job stress leads to cardiovascular disease?

Job stress is costing US Industries $ 300 Billion annuallyDiabetes is costing US $132 billion in 2002In UK Heart disease cost Pounds 1.73 billion in19992.42 billion in informal care and 2.91 billion in “friction period adjusted loss” Total burden 7.06 billion24.1% of Productivity loss due to mortality75.9% to morbidity

Preventing Stress at Work: A Comprehensive Approach

Hold group discussions with employees. Design an employee survey. Measure employee perceptions of job conditions, stress, health, and satisfaction. Collect objective data. Analyze data to identify problem locations and stressful job conditions.

Target source of stress for change.  Propose and prioritize intervention strategies.Communicate planned interventions to employees. Implement Interventions.

Conduct both short- and long-term evaluations.  Measure employee perceptions of job conditions, stress, health, and satisfaction.Include objective measures. Refine the intervention strategy and return to Step 1.

Step 1 - Identify the Problem.

Step 2 - Design and Implement Interventions.

Step 3 - Evaluate the Interventions.

How to Change the Organization to Prevent Job Stress

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 – ChiYogaMeditation

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.

Exercise. Exercise, especially aerobic movement, is a great way to release tension and stress. Stress management techniques, such as biofeedback, yoga, and tai chi, are also excellent ways to treat and reduce the physical symptoms of stress. Try massage therapy, aromatherapy, or meditation. Stretching and controlled breathing can also reduce tension.

Talk. Take a break from the stress and talk out your

problems with a trusted listener. Sharing burdens with a loved one helps reduce your load, even if just psychologically.

Organize. Prevent stress by staying on top of your

responsibilities. Reduce your commitments to keep your schedule under control. Don’t take on more than you can handle, and don’t force yourself to multi-task if it’s stressing you out or the tasks are suffering for it. And remember to save time for fun.

Five Stress Reduction Techniques  

Commit. Treat your body right: eat a healthy diet, take a multi-vitamin, make sure you’re getting enough sleep, and avoid alcohol and other Legal: illegal drugs that may contribute to overall lack of health.

Escape. When nothing else seems to work, it’s OK to escape the source of stress. Whether it’s taking a short break from the stressful task at hand, or treating yourself to a well-deserved vacation, getting physically away from the stress center will help you mentally remove yourself as well.

Five Stress Reduction Techniques contd… 

Self TalkHumourStretchingSelf massageProgressive muscle relaxationDeep breathingMeditation

If all else fails !

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

Tobacco in any form - Definite NO NO

Smoking, chewing and snuff of TobaccoIncreases incidence of brain strokesHeart attacks and peripheral vascular disease

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

Moderate = 300 ml of Beer 60 ml of liquor

“The French Paradox”Red Wine= 2-3 glasses/dayMakes 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

The heART of Living

•Eat smart

•Regular exercise

•Destress

•Relax

•Give up tobacco/alcohol

•Check ups

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 Organization

We spend more time and moneycaring for our cars…….

……Than we do for our body and our heart !

ROUTINE SCREENING TESTSROUTINE SCREENING TESTS

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

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 management

And

Preventive Cardiac Care

No longer a charityButA Corporate Strategy

Harvey Heart

542, TTK Road, Alwarpet,Chennai, 600 018,Tamil Nadu, India

91 44 24311721 /22/23/2491 44 24311726 www.harveyhealthcare.co.in