Anger a Deadly Sin for Heart Patients

Nov. 12, 2006 — -- Tightness in the chest. Sweaty palms. A racing pulse. These consequences of rage are familiar to anyone who has ever let their anger get the best of them.

For certain heart patients, however, sudden death can be officially added to the list, according to a new study.

The findings were presented today at the American Heart Association's Scientific Sessions in Chicago.

The study looked at heart patients who have been fitted with an implantable cardioverter defibrillator (ICD), a tiny device implanted into the heart muscle that automatically delivers a pulse-stabilizing jolt of electricity whenever the heart's rhythm goes out of sync.

In the study, patients were told to call and report their experience any time that their ICD delivered a shock. They were also asked to fill out a questionnaire about their experience and their emotions before the shock.

Following the questionnaire, researchers reviewed the information gathered from the patients' ICDs before and during the event. This information was used to determine if study participants were more likely to experience a life-threatening arrhythmia within an hour of an episode of moderate, or greater, level of anger.

"Prior studies have shown that anger affects the heart's electrical properties, making it more vulnerable to dangerous rhythm disturbances," said Dr. Christine Albert, lead author of the study and director of the Center for Arrhythmia Preventionat Brigham and Women's Hospital in Boston. "Our 'Triggers of Ventricular Arrhythmia' study examined this theory in a population of people who have ICDs, making it possible to look for a connection between a patient's self-reported level of anger and the development of life-threatening heart rhythms."

A total of 199 cases of ventricular fibrillation (VF) or ventricular tachycardia (VT) cases were recorded in the study. These conditions are fatal if not treated with a shock within minutes. And of these episodes, 15, or 7.5 percent, were preceded by at least moderate levels of anger within the hour before ICD discharge.

"We found that it was 3.2 times more likely for VF or VT to develop (prompting a shock from the ICD) after the participant became at least moderately angry, as compared to periods of no anger," Albert said. "If they were very angry, or furious, there was about a 16.7-fold increased risk of having the ICD shock for these life-threatening rhythm disturbances."

"This is significant in that it provides objective data confirming a cause-and-effect relationship between emotions and behavior -- here, anger -- and lethal heart arrhythmias," said Dr. Noel Bairey Merz, medical director and endowed chair of the Women's Health Program at Cedars-Sinai Medical Center in Los Angeles. "Prior to this we had predominantly associative, less direct data."

Because the study points to anger as the cause of the arrhythmias in these cases, it has implications for the interventions that are used to prevent heart patients from experiencing additional cardiac events.

"Doctors and their patients want to avoid these shocks," Albert said. "Our results suggest that emotions, particularly anger, can trigger dangerous rhythm disturbances and ICD shocks. Hopefully, educating doctors, patients and family members about these risks may help to minimize how often the patient experiences anger, and counseling could be considered for patients who have received ICD shocks in conjunction with anger."

In short, teaching these individuals to control their anger could literally put their hearts at ease.

"I agree strongly with the study authors on this point and can even suggest that there are already programs that train patients in coping skills that can reduce their anger levels as well as their blood pressure surges when angry that could be applied to see if they reduce not only anger but the frequency of arrhythmias," said Dr. Redford Williams, director of the Behavioral Medicine Research Center at Duke University in Durham, N.C.

Rage As a Risk Factor?

Whether or not the findings can be generalized to include groups other than those with ICDs is a matter of contention amongst experts in the field. Some note that these patients are unique in this case because of their profoundly weak hearts.

"It is interesting, but it is not particularly relevant to the general population," said Dr. James Stein of the Division of Cardiovascular Medicine at the University of Wisconsin in Madison, Wis. "These patients have abnormal substrate -- that is, they have abnormal hearts.

"I think [the study] adds to our knowledge about predictors of shocks in people with ICDs, but sheds little light on whether or not stress and anger predict heart disease in the general population."

Other experts maintain that the findings can be relevant to others as well.

"This study is important for ICD, CHF [coronary heart failure], CAD [coronary artery disease], post-MI [myocardial infarction, or heart attack] cohorts, as well as healthy persons," said Dr. Melvyn Rubenfire, professor of internal medicine at the University of Michigan in Ann Arbor.

"Of course, this group of patients is at a higher risk for developing arrhythmias, but other patients with CAD [coronary artery disease] are also at risk," Williams said. "There are doubtless large numbers of people out there -- far larger, in fact, than those who have gotten ICDs -- with lesser degrees of arrhythmia who are at risk of suffering effects of stress in general, and arrhythmias in particular."

Either way, the study is not the first to link psychological stress and heart problems. Recent studies have suggested forms of emotional strain other than anger -- such as work-related stress and financial worries -- can also bring about cardiac problems.

"The research in this area is burgeoning, with depression, social isolation and job stress all receiving attention along with hostility and anger," Williams said. "Regardless of the official AHA position right now, research lie this study will eventually define the proper place of psychosocial factors. I'm prepared to predict they will be as prominent as any other major (heart disease risk factors)."

Experts also suggest that other acute emotions, such as terror, can have fatal effects on weak hearts. One case in point is the June 2005 death of a 4-year-old child after riding the "Mission: Space" attraction at Disney's Epcot Center theme park. It was later determined that the child had a pre-existing heart condition.

"It is all based on the neural enervation of the heart," said Dr. Douglas Zipes, distinguished professor emeritus at Indiana University School of Medicine in Bloomington, Ind. "Anger, like the roller coaster, causes increased adrenalin release which can produce (altered heart rhythms) and sudden death. This type of information goes back many years."

Fortunately, so too does the advice on how to safeguard the heart from the ill effects of rage.

"In a larger context, studies like this show the wisdom of universal spiritual truths -- what Aldous Huxley called 'the perennial wisdom' -- such as forgiveness, compassion, and altruism," said Dr. Dean Ornish, clinical professor of medicine at the University of California in San Francisco. "Seen in this context, forgiveness and altruism are 'selfish,' as these increase not only our well-being, but also our survival."