Anger Can Be Deadly By Paula Rasich Reviewed by Elizabeth Klodas, MD, FACC  February 27, 2009--It’s well known that our mental and emotional states impact our health. Now, a small study breaks new ground in explaining how stressful emotions affect the heart. In people with implantable cardioverter defibrillators (ICDs), a device similar to a pacemaker used to treat heart arrhythmias, anger was shown to increase risk of abnormal heart rhythms---the main cause of sudden cardiac death.

To investigate this link, researchers did something novel: they gave 62 patients with implantable ICDs an “emotional” stress test.  At the start of the study, researchers assessed changes in one measure of the heart’s electrical activity called T-wave alternans (TWA) while asking study participants to recall a recent incident that had made them angry. A higher TWA value is a sign of electrical instability in the heart and often precedes an arrhythmic event.

Over the next three years, 10 patients experienced a serious arrhythmia.  And researchers found that those who had the highest TWA values in response to the emotional stress test were 10 times more likely to experience an event than those with lower TWAs. This association held true even after controlling for known risk factors like reduced left ventricular function and past arrhythmias.

What this study suggests is that anger alters the electrical stability of the heart, says lead study author Rachel Lampert, MD, associate professor of medicine at Yale University School of Medicine in New Haven, Connecticut.

“The study demonstrates that surges of emotional stress could actually provoke arrhythmias,” says Eric Rashba, MD, professor of medicine at Stony Brook University Medical Center in Stony Brook, New York. In the future, the traditional exercise test along with this new emotional test might be used to more precisely predict who is going to have arrhythmia problems, he adds.

Each year, tens of thousands of people get ICDs and that number will likely continue to rise. “If we know that anger can potentially precipitate electrical instability and arrhythmias, then therapeutic interventions such as stress management which are designed to block the impact that these emotions have on your body may be a way of decreasing arrhythmias in patients with ICDs,” says Dr. Lampert. “That is something we are now studying.”

The study findings and editorial comment are published in the March 3, 2009 issue of the Journal of the American College of Cardiology.  

Sources:

Lampert R, et al. Anger-Induced T-Wave Alternans Predicts Future Ventricular Arrhythmias in Patients with Implantable Cardioverter-Defibrillators. Journal of the American College of Cardiology, 2009.

Rashba EJ.  Editorial Comment: Anger Management May Save Your Life. New Insights Into Emotional Precipitants of Ventricular Arrhythmias.  Journal of the American College of Cardiology, 2009. 

Rachel Lampert, MD, Associate Professor of Medicine, Yale University School of Medicine, New Haven, Connecticut.

Eric J. Rashba, MD, Professor of Medicine, Stony Brook Medical Center, Stony Brook, New York.