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Q. How is the heart physically affected by stress?

A. There’s actually a direct biochemical connection between stress and our bodies. We are pre-wired to have a flight or fight response in fearful situations. At those times, the brain sends a signal to the adrenal glands to create stress hormones, which can be very helpful in giving us energy, strength, and even making us run faster in frightening situations. But, those stress hormones can also have a negative impact our bodies. These same chemicals are at work within our bodies when we experience anger or fear in a job situation, for example, and can have toxic results on the body. The adrenaline affects the lining of the blood vessels preventing the artery lining from functioning properly. When the lining doesn’t dilate properly, it can cause angina, a decreased flow of blood to the heart, and atherosclerosis can develop. This scenario has a multifactorial way of injuring the arteries, leading to strokes, heart attacks, or arrhythmias.

Q. What warning signs indicate that stress may be putting a burden on your heart?

Some signs of the harmful effects of stress include chronic anxiety, insomnia, hypertension, and depression. In fact, people who are depressed and have already had a first heart attack are at an even greater risk for a second heart attack. Indirectly, stress can relate to such adverse risk factors as increased smoking, high blood pressure, and high cholesterol. The association of hormones with our body’s circadian rhythm also explains why we see more heart attacks and a higher incidence of arrhythmia in the morning.

Q. What lifestyle activities do you find to be most effective in reducing stress?

A. Studies show a relationship between coronary disease and lifestyle with echocardiograms indicating angina can be reversed by using various forms of stress reduction. Stress management programs benefit patients significantly. Feedback meditation, focused breathing for 10 minutes a day, or exercising for 30 minutes three times a week all have a longer-lasting effect than the actual amount of time spent on the specific activity. I help my patients adopt stress-reduction techniques that I know will have long-term benefits. For instance, relaxation techniques can lead to a reduction in stress and, in turn, help patients to stop smoking. Similarly, if a patient’s blood pressure is elevated, by teaching them focused breathing, I’ve seen their blood pressure drop five or 10 millimeters within just a few minutes. MRIs show that specific areas of the brain, which light up during exercise, are the same areas of the brain that are stimulated by narcotics. The stress reduction methods don’t cost money and have no side effects except for happiness. I also recommend logging in five things you’re grateful for at the very end of your meditation, which helps reduce depression if incorporated into your general life. You can adopt any of these techniques on your own or use a guided meditation app, such as ‘Breathe to Relax’ or ‘Calm,’ or just simply relax to spa music.

Q. In addition to lifestyle changes, what treatments are available for chronic stress?

A. Science is now catching up to the benefits of meditation methods that have long been used in eastern cultures. But, you can acquire the benefits of meditation and other relaxation techniques very quickly. You don’t need special equipment and you don’t need to submit paperwork to your health insurance company. You can help mitigate the risks of atherosclerosis, increased risk of cardiac death, and arrhythmias on your own. If you know you have stressors that can be changed, change them. You have nothing to lose and everything to gain.

Q. How effective are those treatments?

A. I personally experience benefits from the very same relaxation methods that I teach my patients. These techniques help me to be more tuned in to people, including my patients. In addition to relaxation, there are also effective pharmacologic treatments. For certain people, antidepressants can be very effective. But, I’m concerned about those doctors who tend to over prescribe antidepressants, which can lead to other risks. On the other hand, if you’re able to incorporate relaxation techniques, such as meditation, into your general life, it’s possible to create calm and focus and produce the same physiological result as medication.

Board-certified in Internal Medicine and Cardiovascular Disease, Dr. Fishbach is in practice with the NewYork-Presbyterian Medical Group and is Director of the Cardiac Catheterization Unit at NewYork-Presbyterian/Lawrence Hospital. He also serves as Associate Clinical Professor of Medicine at Columbia University College of Physicians and Surgeons and Assistant Professor at Albert Einstein College of Medicine. He was named Top Doctor by Westchester Magazine in 2015 and 2016.

New/York-Presbyterian Lawrence Hospital
Chief of Cardiovascular Radiation Services
688 White Plains Road
​Scarsdale, NY 10583
914-722-6300
www.nyplawrence.org

Mitchell Fishbach, MD
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