Getting to the heart of stress and its impact on the CV system
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As mental health continues to affect more than 10% of the global population, discoveries related to the physical implications of mental health conditions, including stress, continue to become more apparent each year.
In fact, recent research indicates that CVD is the most common cause of death among patients who have been diagnosed with a mental illness. It is critical that providers and patients alike recognize these connections, communicate how symptoms can present, and work together around proactive measures to relieve stress on the heart. This should go beyond BP monitoring (which is still helpful) to also incorporate the goal to deliver a personalized approach, based on different patient needs and lifestyles.
In particular, there is a proven association between mental illness and blood pressure variability (BPV). New research highlighted in BioMedical Engineering OnLine indicates that mental health does, in fact, have serious implications on CV health.
To accurately assess BPV and its changes as they relate to mental health, physicians in this study broke down the method of studying BPV into the categories of short term, long term, and ultra-short term. The most conclusive evidence after analyzing these 12 studies is that mental illness is significantly associated with increased BPV in younger and middle-aged adults.
The symptoms of BPV were found to be present in patients diagnosed with depression and anxiety as well as panic and stress disorder. In practice, we often see BPV as a secondary symptom of other conditions such as diabetes and kidney disease. We now know this also includes mental illness.
Educating patients
With the knowledge that mental illness can contribute to the deterioration of autonomic cardiac functions, it is important that patients are properly educated on how to identify the signs and symptoms that become present when the deterioration of autonomic cardiac functions begins.
As BPV affects the body, myriad symptoms can present. Such as we see with individuals who are experiencing high BP, symptoms of BPV are most often affiliated with irregularities in the head including dizziness, lightheadedness, severe headaches, complications with vision, bloodshot eyes and unusual dehydration.
Symptoms can also transcend to other parts of the body, and we often see nausea, chest pain, difficulty breathing and fatigue in patients with irregular BP. Patients can experience one or multiple of these symptoms but might not recognize the connection to heart health. Education is key in making sure our patients know when it is time for concern.
Prevention as priority
Beyond recognizing symptoms, proper education for both the physician and patient is the most important method for preventing the effects of stress and mental health on the CV system.
To take it a step further, create a personalized approach to care, especially when treatment becomes necessary, so that the patient can easily adopt changes into their lifestyle. Everyone has a different threshold for stress, different triggers, etc. What works for one patient may not work for the next.
We can achieve a personalized approach by helping our patients manage their mental health before it begins to translate into complications of the CV system. There are many methods, both inpatient and outpatient, that can be conducted to address mental health at its root.
For outpatient care, there are many daily at-home practices for addressing mental health. This can include reducing stress and anxiety in day-to-day life, sleeping sufficiently through the night, monitoring your diet and reducing consumption of alcohol and tobacco. Patients and providers can have conversations around different means to achieve these goals.
Many institutions, such as ours, Atlantic Health System, offer a variety of inpatient mental health resources for patients who are unable to address their condition on their own. Programs such as group psychotherapy, individual and family counseling, activities therapy and medication management have all proved effective in helping patients get a grasp on their mental health.
Physicians must consider the link between mental health and CV health as to better care of their patients. It is also the responsibility of the physician to educate their patients on how to identify the risk factors, signs and symptoms of BPV.
Should these risk factors begin to manifest in the CV health of patients, personalized approaches for each patient are necessary to ensure that these risk factors are addressed and alleviated. For patients in the early stages of mental health complications, day-to-day practices can be recommended to mitigate the effects of stress and other mental disorders on the heart. In other, more severe cases, inpatient programs may be necessary.
Regardless of severity, it is crucial to work closely with your patient to identify a personalized care regimen that will effectively address their stress and mental health complications before their BP is affected. It is our duty as physicians to use this knowledge to provide better care to our communities.
References:
- Dattani S, et al. Mental health. ourworldindata.org/mental-health. Published April 2018. Accessed Dec. 29, 2022.
- Shahimi NH, et al. Biomed Eng Online. 2022;doi:10.1186/s12938-022-00985-w.
For more information:
Anjali Dutta, MD, is a cardiovascular specialist at Morristown Medical Center, part of Atlantic Health System, in Morristown, New Jersey. Elana Monchar, MD, is chair of the department of psychiatry at Morristown Medical Center. The authors can be reached at Morristown Medical Center, 100 Madison Ave., Morristown, NJ 07960.
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